Dean J Kereiakes1, Robert W Yeh2, Joseph M Massaro3, Priscilla Driscoll-Shempp4, Donald E Cutlip5, P Gabriel Steg6, Anthony H Gershlick7, Harald Darius8, Ian T Meredith9, John Ormiston10, Jean-François Tanguay11, Stephan Windecker12, Kirk N Garratt13, David E Kandzari14, David P Lee15, Daniel I Simon16, Adrian Corneliu Iancu17, Jaroslaw Trebacz18, Laura Mauri19. 1. Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio. 2. Harvard Clinical Research Institute, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts. 3. Harvard Clinical Research Institute, Boston, Massachusetts; Boston University School of Public Health, Boston, Massachusetts. 4. Harvard Clinical Research Institute, Boston, Massachusetts. 5. Harvard Clinical Research Institute, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Department of Medicine, Cardiology Division, Boston, Massachusetts. 6. Université Paris-Diderot, Paris, France, INSERM U-1148, Paris, France; Hôpital Bichat, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, United Kingdom. 7. Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester, Leicester, United Kingdom. 8. Vivantes Neukoelln Medical Center, Department of Cardiology, Angiology, Nephrology and Intensive Care Medicine, Berlin, Germany. 9. Monash Heart, Monash Health, Monash University, Victoria, Australia. 10. Mercy Hospital, Auckland, New Zealand. 11. Montreal Heart Institute, Department of Medicine/Division of Interventional Cardiology, Université de Montréal, Department of Medicine, Montreal, Canada. 12. Bern University Hospital, Department of Cardiology, Bern, Switzerland. 13. Center for Heart and Vascular Health, Christiana Care, Wilmington, Delaware. 14. Piedmont Heart Institute, Atlanta, Georgia. 15. Stanford University, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California. 16. University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio. 17. Heart Institute, University of Medicine Iuliu Hatieganu, Cluj Napoca, Romania. 18. Jan Pawel II Hospital Krakow, Krakow, Poland. 19. Harvard Clinical Research Institute, Boston, Massachusetts; Brigham and Women's Hospital, Division of Cardiovascular Medicine, Boston, Massachusetts. Electronic address: lmauri1@partners.org.
Abstract
OBJECTIVES: This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS. BACKGROUND: Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES. METHODS: Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months. RESULTS: Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001). CONCLUSIONS: DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).
RCT Entities:
OBJECTIVES: This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS. BACKGROUND: Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES. METHODS: Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months. RESULTS: Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001). CONCLUSIONS: DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).
Authors: Łukasz Kołtowski; Jacek Legutko; Krzysztof J Filipiak; Artur Dziewierz; Stanisław Bartuś; Paweł Buszman; Piotr Buszman; Dariusz Ciećwierz; Maciej Dąbrowski; Sławomir Dobrzycki; Robert Gil; Jarosław Gorący; Marek Grygier; Miłosz Jaguszewski; Janusz Kochman; Jacek Kubica; Wiktor Kuliczkowki; Piotr Lodziński; Andrzej Ochała; Krzysztof Reczuch; Adam Witkowski; Wojciech Wojakowski; Jarosław Wójcik; Dariusz Dudek Journal: Cardiol J Date: 2019 Impact factor: 2.737
Authors: Ada C Stefanescu Schmidt; Dean J Kereiakes; Donald E Cutlip; Robert W Yeh; Ralph B D'Agostino; Joseph M Massaro; Wen-Hua Hsieh; Laura Mauri Journal: Circulation Date: 2017-02-22 Impact factor: 29.690
Authors: Amit N Vora; Tracy Y Wang; Shuang Li; Karen Chiswell; Connie Hess; Renato D Lopes; Sunil V Rao; Eric D Peterson Journal: J Am Heart Assoc Date: 2017-08-21 Impact factor: 5.501