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Extended DAPT failed to improve outcomes with DES
An additional 2 years of dual antiplatelet therapy did not improve cardiac outcomes in a cohort of patients treated with a drug-eluting stent.
Researchers conducted the prospective, multicenter, open-label, randomized comparison trial to further elucidate the risks and benefits of long-term DAPT.
The analysis was conducted at 24 clinical centers in Korea and included 5,045 patients enrolled between July 2007 and July 2011. Eligible participants had received DES and had no MACE or major bleeding for at least 12 months after implantation.
There were 2,514 patients randomly assigned aspirin alone and 2,531 assigned clopidogrel plus aspirin.
A composite of mortality from cardiac causes, MI or stroke within 24 months of randomization served as the primary outcome measure.
Fifty-seven (2.4%) patients in the aspirin alone group reached the primary endpoint at 24 months compared with 61 (2.6%) in the combination therapy group (HR=0.94; 95% CI, 0.66-1.35).
No significant differences were reported between the two groups regarding individual risk for all-cause mortality, MI, stent thrombosis or stroke. Major bleeding rates were 1.1% for monotherapy and 1.4% for dual therapy (HR=0.71; 95% CI, 0.42-1.2).
“Among patients who were on 12-month DAPT without complications, an additional 24 months of DAPT vs. aspirin alone did not reduce the risk of the composite endpoint of death from cardiac causes, [MI] or stroke,” the researchers concluded.
Disclosure: Researchers reported financial relationships with Abbott Vascular, Boston Scientific, Medtronic and Sanofi-Aventis Korea. See the study for the full list of financial disclosures.