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Prolonged DAPT after PCI does not reduce major cardiovascular events in patients with diabetes

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NEW ORLEANS — Individuals with diabetes who underwent dual antiplatelet therapy for 1 year after undergoing percutaneous coronary intervention had similar myocardial infarction, stroke and major bleeding outcomes as patients who received aspirin alone, according to study results presented at the American Heart Association Scientific Sessions.

Using data from the FREEDOM trial, Jean-Francois Tanguay, MD, of the Montreal Heart Institute, and colleagues conducted an analysis of 682 patients who experienced no cardiovascular event up to 1 year after PCI to assess composite all-cause mortality, nonfatal myocardial infarction and stroke from 1 year up to 5 years after procedure for patients on DAPT or aspirin alone.

The expectation was that DAPT would have been associated with reduced long-term major cardiovascular outcomes, Tanguay said during the presentation.

The results demonstrated that patients who received DAPT (n = 357) were at a slightly higher increased risk for composite events compared with the patient population that received aspirin alone (adjusted HR = 1.48; 95% CI, 0.92-2.4). All-cause mortality (aHR = 1.37; 95% CI, 0.72-2.65), myocardial infarction (aHR = 1.56; 95% CI, 0.78-3.14), stroke (aHR = 2.03; 95% CI, 0.38-10.78) and major bleeding (aHR = 1.78; 95% CI, 0.33-9.72) occurred more frequently in patients who received DAPT, however the differences were not significant.

“Prolonged DAPT after 12 months after PCI was not associated with a reduction in the composite ischemic outcome,” Tanguay said. “There was no difference that could be observed with the higher DAPT score compared with the lower DAPT score, both with ischemic and bleeding outcomes. These findings may reflect some decision-making from doctors around the use of DAPT in the individual patient or unmeasured risk factors.” – by Ryan McDonald

Reference: Tanguay JF, et al. IN.AOS.855 - Hot Trials in Interventional Cardiology. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Disclosure: Tanguay reports no relevant financial disclosures.