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- Title
Optimal duration of DAPT after second-generation drug-eluting stent in acute coronary syndrome.
- Authors
Jang, Ji-Yong; Shin, Dong-Ho; Kim, Jung-Sun; Hong, Sung-Jin; Ahn, Chul-Min; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Park, Kyung Woo; Gwon, Hyeon-Cheol; Kim, Hyo-Soo; Jang, Yangsoo
- Abstract
Background: We evaluated optimal duration of dual antiplatelet therapy (DAPT) after second-generation drug-eluting stent (DES) implantation in acute coronary syndrome (ACS). Material and methods: From pooled analysis of three randomized clinical trials (EXCELLENT, IVUS-XPL, RESET), a total of 2,216 patient with ACS undergoing second-generation DES implantation were selected. Each study randomized patients to a short-duration DAPT arm (n = 1119; ≤6 months) or a standard-duration DAPT arm (n = 1097; ≥12 months). Two-thirds of patients were male, and their mean age was 63 years. Mean DAPT durations were 164 ±76 and 359 ±68 days, respectively. The primary endpoint was composite of cardiac death, myocardial infarction, stent thrombosis, stroke or major bleeding during the first 12 months after implantation, analyzed according to the intention-to-treat population. Results: Demographic characteristics were balanced between groups. Mean DAPT duration was 164 and 359 days, respectively. Primary endpoint occurred in 22 patients with short-DAPT and 21 patients with standard-DAPT (2.0% versus 1.9%; hazard ratio [HR] 1.03; 95% confidence interval [CI] 0.56–1.86; p = 0.94). Landmark analysis after six-months, no significant difference in primary endpoint between short and standard duration DAPT (1.0% versus 0.8%; HR 1.22; 95% CI 0.51–2.95; p = 0.66). Conclusions: Short-duration DAPT (≤6 months) demonstrated a similar incidence of net adverse cardiovascular and clinical events at 12 months after second-generation DES in ACS compared with standard duration DAPT (≥12 months). Clinical trial registration: EXCELLENT (ClinicalTrials.gov, ), RESET (ClinicalTrials.gov, ), IVUS-XPL (ClinicalTrials.gov, )
- Subjects
ACUTE coronary syndrome; PLATELET aggregation inhibitors; CARDIAC arrest; THROMBOSIS; MYOCARDIAL infarction
- Publication
PLoS ONE, 2018, Vol 13, Issue 11, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0207386