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Dual antiplatelet therapy after cardiac events may carry risks
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American College of Cardiology 59th Annual Scientific Session
ATLANTA – Dual antiplatelet therapy may not reduce rates of MI or cardiac death more than aspirin monotherapy, and has the potential to create risk for coronary patients after receiving a drug-eluting stent, according to new findings.
“The use of dual antiplatelet therapy for an extended period beyond 12 months among patients who received drug-eluting stents was not significantly more effective than aspirin-only therapy in reducing the rate of cardiac death or MI,” Seung-Jung Park, MD, of the Asan Medical Center, Seoul, South Korea, said yesterday. “These findings provide a key direction for the future of post-drug-eluting stent treatment.”
Researchers randomly assigned 2,701 patients who had received drug-eluting stents and had been free of cerebrovascular events and major bleeding for one year to two cohorts: one received clopidogrel plus aspirin (n=1,357) and the other aspirin alone (n=1,344). A composite of MI or death from cardiac causes served as the primary endpoint.
During a median follow-up of 19.2 months, the cumulative risk for the primary endpoint was 1.8% for patients receiving dual antiplatelet therapy compared with 1.2% for their aspirin-only counterparts (HR=1.65; 95% CI, 0.80-3.36). Findings show that the dual therapy group had an increase in the composite risk of MI, stroke or death from any cause (HR= 1.73; 95% CI, 0.99-3.00) as well as from cardiac causes (HR=1.84; 95% CI, 0.99-3.45), but this risk did not reach statistical significance.
“In this large, multicenter cohort of consecutive patients with unprotected left main disease, there was no significant difference in the risk of death and a composite outcome of death, Q-wave MI or stroke between the percutaneous coronary intervention and the bypass surgery groups during five years of follow-up,” Park said. “These results were consistent when bare metal stents or drug-eluting stents were compared with bypass surgery. By contrast, the rate of target vessel revascularization was significantly lower in the bypass surgery group than in the PCI group, without regard to type of stent.”
Both the researchers and some session panelists stated that more research is needed to ascertain the validity of the findings. Corroboration from larger randomized trials with more extensive and longer follow-up would be beneficial to further understanding the risks and rewards of antiplatelet therapy, they suggested.
For more information:
- Park SJ. LBCT III. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
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