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Stent type may influence optimal duration of DAPT
The choice of stent influences optimal duration of dual antiplatelet therapy and does not support a clear association between stent potency and vulnerability to shorter therapy durations, study results have shown.
The PRODIGY study assessed device-specific outcomes relative to different durations of DAPT for 2,013 patients randomly assigned to everolimus-eluting stents (EES), paclitaxel-eluting stents (PES), zotarolimus-eluting stents (ZES) or bare-metal stents.
Each stent group underwent up to 6 or 24 months of clopidogrel therapy. A composite endpoint of death, MI or cerebrovascular accident did not differ in patients receiving BMS (HR=0.89; 95% CI, 0.54-1.45), PES (HR=0.74; 95% CI, 0.43-1.25) or EES (HR=0.63; 95% CI, 0.33-1.21) implantation across DAPT groups. The composite endpoint was significantly higher in ZES patients undergoing long-term DAPT therapy compared with short-term therapy (HR=2.85; P=.0018), with positive interaction testing (P=.004).
Heterogeneity of the endpoint and other secondary clinical outcomes persisted across stent types at 6 months. Patients receiving PES had a significantly higher rate of definite or probable and definite, probable or possible stent thrombosis with the short-term DAPT regimen.
Researchers said there was no association in absolute or relative terms between stent potency in inhibiting intimal hyperplasia and greater vulnerability to shorter DAPT therapies.
“The main findings of our analysis challenge current recommendations endorsing a clear-cut dichotomy of BMS vs. DES for the need of prolonged DAPT after stenting,” the researchers wrote. “Furthermore, our data suggest minimal duration of clopidogrel therapy may differ among DES, irrespective of stent potency in inhibiting intimal hyperplasia.”
Disclosure: Valgimigli reports receiving honoraria for lectures/advisory board and research grants from Eli Lilly, Iroko, Medtronic and Merck; honoraria for advisory board and lectures from Abbott Vascular, Daiichi Sankyo/Eli Lilly, St. Jude Medical and The Medicines Company; and lectures from CID, Cordis and Terumo.