Benefits and Risks of Extended DAPT After EES Studied

January 25, 2016—Findings from a study of dual-antiplatelet therapy that aimed to characterize outcomes for everolimus-eluting stent (EES)–treated patients according to treatment with continued thienopyridine plus aspirin versus aspirin alone at 12 to 30 months after stenting were published by James B. Hermiller, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2016;9:138–147).

The DAPT study of continued thienopyridine plus aspirin beyond 1 year after coronary stenting showed a reduction of ischemic events, given low rates of stent thrombosis and myocardial infarction (MI) for current drug-eluting stents. The investigators examined outcomes among EES-treated patients in the DAPT study.

As summarized in JACC: Cardiovascular Interventions, the DAPT study enrolled 25,682 patients (11,308 EES-treated) after coronary stenting. After 12 months of treatment with thienopyridine and aspirin, eligible patients continued treatment with aspirin and 9,961 (4,703 with EES) were randomized to 18 months of continued thienopyridine or placebo. Stent type was not randomized, and the EES subset analysis was post hoc.

The investigators reported that among EES-treated patients, continued thienopyridine (versus placebo) reduced stent thrombosis (0.3% vs 0.7%; hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.15–0.97; P = .04) and MI (2.1% vs 3.2%; HR, 0.63; 95% CI, 0.44–0.91; P = .01), but did not reduce a composite of death, MI, and stroke (4.3% vs 4.5%; HR, 0.89; 95% CI, 0.67–1.18; P = .42), and increased moderate/severe bleeding (2.5% vs 1.3%; HR, 1.79; 95% CI, 1.15–2.8; P = .01) and death (2.2% vs 1.1%; HR, 1.8; 95% CI, 1.11–2.92; P = .02). Death due to cancer and not related to bleeding was increased (0.64% vs 0.17%; P = .01).

In EES-treated patients, significant reductions in stent thrombosis and MI and an increase in bleeding were observed with continued thienopyridine beyond 1 year compared with aspirin alone, concluded the investigators in JACC: Cardiovascular Interventions.