DAPT duration does not impact outcomes after PCI with SES
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Among patients who underwent PCI with a sirolimus-eluting stent, short-term and long-term dual antiplatelet therapy conferred similar rates of target vessel failure, researchers reported.
According to data published in the Journal of the American Heart Association, outcomes in PCI with an ultrathin SES with a biodegradable polymer (Orsiro, Biotronik) also did not significantly differ compared with everolimus-eluting stents (Promus, Boston Scientific; Synergy, Boston Scientific; and Xience, Abbott).
“Bleeding after PCI was significantly associated with mortality during follow-up,” Kyeong Ho Yun, MD, of the Regional Cardiocerebrovascular Center of Wonkwang University Hospital in Iksan, South Korea, and colleagues wrote. “Moreover, of patients undergoing PCI, the proportion of patients with high bleeding risk is increasing. Therefore, shortening of DAPT duration or avoidance of unnecessary prolonged DAPT is of paramount importance.”
The SMART-CHOICE randomized trial compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT in 2,993 patients who underwent PCI.
As Healio previously reported at the 2019 American College of Cardiology Scientific Sessions, 3-month DAPT after PCI while continuing P2Y12 inhibitor monotherapy did not confer any increased risk for MI, death or stroke compared with 1-year DAPT.
For this subgroup analysis, researchers evaluated the safety of 3-month DAPT among the 972 patients who received SES. They also compared outcomes in SES vs. EES among those who received 3-month DAPT.
The primary endpoint was TVF, defined as a composite of cardiac death, target vessel-related MI, or target vessel revascularization at 12 months following PCI.
TVF after PCI with SES
In a prespecified subgroup analysis of patients from SMART-CHOICE who had PCI with the SES, researchers observed that the cumulative rate of primary endpoint was 1.7% in the 3-month DAPT group compared with 2.9% in the 12-month DAPT group (HR = 0.58; 95% CI, 0.24-1.39; P = .22).
According to the study, the cumulative rate of the net adverse clinical events did not differ between the 3- and 12-month DAPT groups (3.4% vs. 3.3%, respectively; HR = 1.02; 95% CI, 0.51-2.04; P = .95) and no stent thrombosis occurred in either group.
Landmark analyses did not change the results.
SES vs. EES
In a post hoc analysis of patients assigned 3-month DAPT, the researchers compared 1,014 patients treated with EES and 481 patients treated with SES.
According to the study, IVUS during PCI was less frequently used with the SES compared with the EES (18.9% vs. 27.7%; P = .0002).
Researchers observed that in those assigned 3-month DAPT, the cumulative rates of the primary endpoint were 1.7% for those treated with the SES and 1.8% for those treated with an EES (HR = 0.96; 95% CI, 0.41-2.22; P = 0.92).
“Given that the performances of current-generation DES are excellent and comparable to each other, extrapolation of the results of these trials to other DES may be possible,” the researchers wrote. “However, we believe that it is desirable and prudent to demonstrate the safety of short-duration DAPT in each stent. The results of the present study support that the short duration of DAPT may be feasible and safe in patients receiving Orsiro stents like other current-generation DES.”
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