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RESOLUTE: Low stent thrombosis rates reported with DAPT interruption
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WASHINGTON — Interruption of dual antiplatelet therapy between 1 month and 1 year after PCI was associated with low stent thrombosis rates, concluded findings presented at American College of Cardiology Scientific Sessions.
David Kandzari, MD, of the Piedmont Heart Institute, Atlanta, and colleagues presented pooled patient data from eight clinical trials associated with the RESOLUTE Global Clinical Program. The current analysis included 1-year data accounting for 7,131 patients who received a Resolute zotarolimus-eluting stent (Medtronic).
The researchers sought to determine outcomes in patients in whom DAPT therapy was interrupted, which was defined as a break from the medications of at least 3 days. This included temporary interruptions or permanent discontinuation of the drugs. DAPT interruption stratification was based on whether it occurred in the first month or between the first month and the first year after PCI. Further stratification was based on temporary or permanent interruption, and whether aspirin, a thienopyridine or both were used.
David Kandzari
Stent thrombosis, cardiac death and target vessel MI served as outcome measures. Patients who did not interrupt DAPT therapy also were included in the analysis.
In the no interruption group, the subsequent rate of stent thrombosis at 1 year was 0.73%. For patients who had an interruption of ≥3 days, if the interruption occurred in the first month, that rate was 3.78%. There were no subsequent stent thrombosis events between months one and 12 in the interruption group.
Cardiac death or target vessel MI rates through 1 year were 3.9% in the no interruption group and 7.3% among patients who interrupted therapy for ≥3 days in the first month. The subsequent rate of cardiac death or MI for patients who interrupted therapy between one and 12 months was 1.1%.
“While we still need to remain adherent to societal guidelines endorsing longer-term durations of DAPT and by no means are these data a recommendation to support abbreviated durations of DAPT or earlier interruption, at the same time they do quantify very favorable low risk adverse events when interruption occurs after the first month,” Kandzari told Cardiology Today’s Intervention. “[The data] also remind us of the excessive risk when interruption occurs within the first month of stent revascularization.”
For more information:
Kandzari D. Session 2908. Pharmacotherapy and PCI. Presented at: American College of Cardiology Scientific Sessions; March 29-31, 2014; Washington, DC.
Disclosure: Kandzari reports research/grant support from Abbott Vascular, Boston Scientific and Medtronic, and being a consultant for Biotronik, Boston Scientific, Medtronic and Mycell Technologies.