Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting Coronary Stents The Dual Antiplatelet Therapy Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Kereiakes, D. J., Yeh, R. W., Massaro, J. M., Driscoll-Shempp, P., Cutlip, D. E., Steg, P. G., Gershlick, A. H., Darius, H., Meredith, I. T., Ormiston, J., Tanguay, J. F., Windecker, S., Garratt, K. N., Kandzari, D. E., Lee, D. P., Simon, D. I., Iancu, A. C., Trebacz, J., Mauri, L. 2015; 313 (11): 1113-1121


Despite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown.To compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in patients treated with BMS taking aspirin and (2) treatment duration effect within the combined cohorts of randomized patients treated with DES or BMS as prespecified secondary analyses.International, multicenter, randomized, double-blinded, placebo-controlled trial comparing extended (30-months) thienopyridine vs placebo in patients taking aspirin who completed 12 months of DAPT without bleeding or ischemic events after receiving stents. The study was initiated in August 2009 with the last follow-up visit in May 2014.Continued thienopyridine or placebo at months 12 through 30 after stent placement, in 11,648 randomized patients treated with aspirin, of whom 1687 received BMS and 9961 DES.Stent thrombosis, MACCE, and moderate or severe bleeding.Among 1687 patients treated with BMS who were randomized to continued thienopyridine vs placebo, rates of stent thrombosis were 0.5% vs 1.11% (n?=?4 vs 9; hazard ratio [HR], 0.49; 95% CI, 0.15-1.64; P?=?.24), rates of MACCE were 4.04% vs 4.69% (n?=?33 vs 38; HR, 0.92; 95% CI, 0.57-1.47; P?=?.72), and rates of moderate/severe bleeding were 2.03% vs 0.90% (n?=?16 vs 7; P?=?.07), respectively. Among all 11,648 randomized patients (both BMS and DES), stent thrombosis rates were 0.41% vs 1.32% (n?=?23 vs 74; HR, 0.31; 95% CI, 0.19-0.50; P?

View details for DOI 10.1001/jama.2015.1671

View details for PubMedID 25781440