Department of Interventional Cardiology, Piedmont Heart Institute, Suite 300, 275 Collier Road, Atlanta, Georgia 30309, USA.
JACC Cardiovasc Interv. 2011 Oct;4(10):1119-28. doi: 10.1016/j.jcin.2011.06.017.
We sought to evaluate differences in late safety outcomes relative to dual antiplatelet therapy (DAPT) duration in patients treated with zotarolimus-eluting stents (ZES).
Despite treatment recommendations for at least 12 months of DAPT following drug-eluting stent revascularization, device-specific outcomes relative to DAPT duration are absent.
Among 2,032 patients undergoing percutaneous coronary revascularization with ZES in 5 trials, late safety events were compared relative to DAPT duration for patients with ≥ 6 months DAPT adherence and survival free of major ischemic and bleeding events.
A total of 1,414 event-free patients on DAPT at 6 months were identified. Patient group comparisons relative to DAPT included: 6 months versus ≥ 12 months, and 6 months versus ≥ 24 months. Through 3 years, risk-adjusted ischemic event rates did not significantly differ between groups: 6 versus ≥ 12 months: death (2.7% vs. 2.2%), myocardial infarction (MI, 0.3% vs. 1.1%), and definite/probable stent thrombosis (ST, 0.3% vs. 0%); 6 versus ≥ 24 months: death (1.6% vs. 1.6%), MI (0.4% vs. 1.2%), and definite/probable ST (0.1% vs. 0.2%). Composite events also did not statistically vary between DAPT durations. In multivariable analysis, 6-month versus longer DAPT duration was not associated with increased likelihood of thrombotic events at 3-year follow-up. Major bleeding was negligible across groups.
Among patients treated with ZES, late-term events of death, MI, stroke, and ST do not significantly differ between patients taking 6 months DAPT compared with continuation beyond 1 year. These findings merit further study to identify the appropriate duration of DAPT according to specific drug-eluting stents.
我们旨在评估接受依维莫司洗脱支架（ZES）治疗的患者，双联抗血小板治疗（DAPT）持续时间与晚期安全性结局的差异。
尽管药物洗脱支架血运重建后推荐至少 12 个月的 DAPT，但缺乏与 DAPT 持续时间相关的特定器械结局。
在 5 项试验中，有 2032 例接受 ZES 经皮冠状动脉血运重建的患者，根据≥6 个月 DAPT 依从性和无主要缺血和出血事件的生存情况，比较晚期安全性事件与 DAPT 持续时间的关系。
共确定了 1414 例在 6 个月时无 DAPT 事件的患者。DAPT 分组比较包括：6 个月与≥12 个月，以及 6 个月与≥24 个月。在 3 年时，风险调整后的缺血性事件发生率在各组之间没有显著差异：6 个月与≥12 个月：死亡（2.7%比 2.2%），心肌梗死（MI，0.3%比 1.1%）和确定/可能的支架血栓形成（ST，0.3%比 0%）；6 个月与≥24 个月：死亡（1.6%比 1.6%），MI（0.4%比 1.2%）和确定/可能的 ST（0.1%比 0.2%）。复合事件在 DAPT 持续时间之间也没有统计学差异。多变量分析显示，与较长的 DAPT 持续时间相比，6 个月与 DAPT 持续时间较短与 3 年随访时血栓形成事件的发生几率增加无关。各组大出血均较少。
在接受 ZES 治疗的患者中，与 1 年以上的 DAPT 持续时间相比，接受 6 个月 DAPT 的患者在晚期死亡、MI、卒中和 ST 方面的事件发生率没有显著差异。这些发现值得进一步研究，以根据特定的药物洗脱支架确定适当的 DAPT 持续时间。
