Two-Year Data Published From ADAPT-DES

December 17, 2015—Tomotaka Dohi, MD, et al published 2-year follow-up data from the ADAPT-DES study on the etiology, frequency, and clinical outcomes of myocardial infarction (MI) after successful drug-eluting stent (DES) implantation. The findings are available online ahead of print in Circulation: Cardiovascular Interventions.

The ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study was a prospective, multicenter registry study of 8,582 patients undergoing successful DES implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, the investigators analyzed the pathogenesis, frequency, and long-term consequences of nonperiprocedural MI in 8,454 patients.

As summarized in Circulation: Cardiovascular Interventions, MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 days. The 263 MIs were subclassified as spontaneous MI (n = 78; 29.7%), secondary or indeterminate MI (n = 64; 24.3%), stent thrombosis-related MI (n = 63; 24%), and in-stent restenosis-related MI (n = 58; 22.1%).

The investigators found that multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes presentation, diabetes mellitus, current smoker, multivessel disease, treatment of an in-stent restenotic lesion), laboratory findings (low baseline hemoglobin and reduced creatinine clearance), antiplatelet agent-related factors (higher on-treatment platelet P2Y12 receptor reactivity and premature thienopyridine discontinuation), and not being on a statin at discharge.

Patients who experienced an MI during the follow-up period had significantly greater 2-year mortality than those without MI (17.3% [42 deaths] vs 3.4% [265 deaths]; P < .001). By multivariable analysis, the adjusted hazard ratio (95% confidence interval) for subsequent mortality during follow-up was 2.17 in patients with versus without a nonperiprocedural MI (P = .03).

The occurrence of a nonperiprocedural MI within 2 years after successful DES implantation is relatively infrequent, but has numerous etiologies and is significantly associated with subsequent mortality, concluded the investigators in Circulation: Cardiovascular Interventions.