SCAI Responds to DAPT Study on Extending Therapy

November 16, 2014—The Society for Cardiovascular Angiography and Interventions (SCAI) issued a statement responding to the DAPT Study presented at the annual American Heart Association 2014 scientific sessions in Chicago, Illinois.

The DAPT Study compared 12 and 30 months of dual-antiplatelet therapy (DAPT) after placement of drug-eluting stents (DESs). The study was conducted by the Harvard Clinical Research Institute and presented by Principal Investigator Laura Mauri, MD. The results were published simultaneously online in The New England Journal of Medicine. Cardiac Interventions Today coverage of the DAPT Study presentation is available here.

The study looked at the risks and benefits of continuing DAPT beyond 1 year after placement of one or more DESs as compared with aspirin therapy alone. The DAPT Study’s investigators conclude that while continuing DAPT with a thienopyridine (clopidogrel or prasugrel) in addition to aspirin after 1 year significantly reduced the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events, continuation was also associated with increased risk of bleeding.

SCAI stated that given the currently available scientific evidence on antiplatelet therapy, the society recommends that the interventional cardiology community should continue to follow the practice guidelines of 1 year (12 months) of DAPT.

However, the study findings suggest that, in specific patient cohorts, a longer duration of the therapy may be considered. These data contrast with other smaller randomized trials, suggesting that shorter durations of DAPT may be considered, particularly with the use of second-generation DESs. Thus, each physician should use his or her judgment in tailoring therapy to the individual patient, advised SCAI.

SCAI noted the DAPT study found that continuing DAPT after 1 year significantly reduced the rates of stent thrombosis (0.4% vs 1.4%) and major adverse cardiovascular and cerebrovascular events (4.3% vs 5.9%). There was also a significant reduction in myocardial infarction (2.1% vs 4.1%), including myocardial infarction not related to stent thrombosis. Although there was a modest increase in overall mortality among the patients on extended DAPT, this increase may have been at least partly due to an imbalance in pre-existing cancer in that group. The overall benefit of prolonging DAPT occurred at the expense of increased moderate or severe bleeding.

SCAI stated that this important and robust study adds to the body of scientific literature about how long to continue DAPT after the placement of a DES. The study reinforces the importance of DAPT, which the current clinical guidelines for percutaneous coronary intervention state should be continued for 1 year after placement of a DES, and indicates that extending the therapy may be considered in some patients.

In the SCAI press release, Dominick J. Angiolillo, MD, commented, “While interventional cardiologists may tailor how long antiplatelet therapy is continued based on physician clinical judgment and the individual patient’s needs and treatment goals, the guideline recommendation of 1 year of dual-antiplatelet therapy remains steadfast.”

Dr. Angiolillo continued, “DAPT is one of many studies that address the issue of how long to continue dual-antiplatelet therapy after placement of a drug-eluting stent. We cannot ignore other trials presented this week or earlier trials suggesting shorter durations of dual-antiplatelet therapy for some patients. We will continue to follow guideline-based care, while evaluating the findings of DAPT and the forthcoming PEGASUS trial and how best to implement the implications of those results in clinical practice for the benefit of each individual patient.” Dr. Angiolillo is Associate Professor of Medicine and Director of Cardiovascular Research at the University of Florida College of Medicine in Gainesville, Florida.