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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type
European Heart Journal, Volume 35, No. 29, Year 2014
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Description
Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES ́ vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957). All rights reserved. © 2014 The Author.
Authors & Co-Authors
Camenzind, Edoardo
Switzerland, Geneva
Université de Genève
Boersma, Eric E.
Netherlands, Rotterdam
Erasmus Mc
Wijns, William C.
Belgium, Aalst
Onze Lieve Vrouw Hospital
Mauri, L.
United States, Boston
Brigham and Women's Hospital
Rademaker-Havinga, Tessa A.M.
Netherlands, Rotterdam
Cardialysis bv
Ordoubadi, Farzin Fath
United Kingdom, Manchester
Manchester Royal Infirmary
Suttorp, Maarten Jan
Netherlands, Nieuwegein
St Antonius Ziekehuis
Al Kurdi, Mohammad
Saudi Arabia, Riyadh
Prince Salman Heart Center
Steg, Philippe Gabriel
France, Paris
Université Paris Cité
France, Paris
Inserm
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
United Kingdom, London
Royal Brompton Hospital
Statistics
Citations: 49
Authors: 9
Affiliations: 12
Identifiers
Doi:
10.1093/eurheartj/ehu084
ISSN:
0195668X
e-ISSN:
15229645
Research Areas
Environmental
Genetics And Genomics
Study Design
Cohort Study
Quasi Experimental Study
Study Approach
Quantitative