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PRODIGY: Prolonged DAPT reduced stent thrombosis in patients with lumen narrowing
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Twenty-four months of dual antiplatelet therapy was associated with less stent thrombosis in patients with lumen narrowing but not in patients without lumen narrowing, according to recent findings.
The researchers evaluated 1,754 all-comer patients to determine whether the presence of at least 30% luminal narrowing in the left main or proximal left anterior descending coronary arteries could influence outcomes with regard to duration of DAPT.
The study included 953 patients with left main or proximal left anterior descending lumen narrowing and 801 patients without. Eligible participants qualified for coronary intervention and were randomly assigned 6 or 24 months of DAPT, according to the results. The primary efficacy endpoint was major adverse CV events, including death, MI or cerebrovascular accident, with secondary endpoints including the individual MACE components, CV death and stent thrombosis.
Among patients treated for 24 months, the primary endpoint occurred in 11% of patients with lumen narrowing and 8.1% of those without lumen narrowing (HR = 1.37; 95% CI, 1-1.87). A trend toward increased MI drove this result, the researchers wrote (4.5% for those with lumen narrowing vs. 2.7% for those without; P = .053). After adjustment for clinical and angiographic imbalances between the groups with and without lumen narrowing, there was no significantly increased risk for MACE with lumen narrowing (adjusted HR = 1.22; 95% CI, 0.89-1.68).
The longer DAPT duration halved the incidence of definite, probable or possible stent thrombosis among patients with left main or proximal left anterior narrowing compared with the shorter duration (2.8% vs. 5.6%, HR = 0.45; 95% CI, 0.23-0.89). However, the longer duration significantly increased risk for stent thrombosis in patients without lumen narrowing (5.2% vs. 2.5%, HR = 2.15; 95% CI, 1.01-4.58). This result was consistent regardless of whether patients received stents in the left main or proximal left anterior region (P interaction = .01) or did not (P interaction = .02).
Results of a landmark analysis indicated a significant interaction between the location of CAD and DAPT duration (P interaction = .044). A similar result was reported after exclusion of patients treated with first-generation DES from analysis.
“A prolonged treatment with [DAPT] reduced stent thrombosis in patients with lumen narrowing of the left main and/or proximal left anterior descending coronary artery, but not in those without these angiographic characteristics,” the researchers concluded. “The presence of [CAD] in these segments may be a treatment modifier impacting on the duration of [DAPT].” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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