Nobori Dual Antiplatelet Therapy as Appropriate Duration - NIPPON
Contribution To Literature:
The NIPPON trial showed that short-term dual antiplatelet therapy was not inferior to long-term therapy.
The goal of the trial was to evaluate short-term compared with long-term dual antiplatelet therapy among patients treated with a biodegradable polymer drug-eluting stent.
Patients undergoing percutaneous coronary intervention were randomized to short-term dual antiplatelet therapy (6 months; n = 1,886) versus long-term dual antiplatelet therapy (18 months; n = 1,887).
- Total number of enrollees: 3,773
- Duration of follow-up: 6-18 months
- Mean patient age: 67 years
- Percentage female: 21%
- Percentage with diabetes: 38%
- Age >20 years and <80 years
- Patients with stable or acute coronary syndromes treated with a biodegradable polymer drug-eluting stent
- No known contraindications to dual antiplatelet therapy
- In-stent restenosis
- Treatment of saphenous vein graft or left main lesion
The primary outcome, incidence of all-cause mortality, myocardial infarction, stroke, and major bleeding, occurred in 2.1% of the short-term dual antiplatelet therapy group versus 1.5% of the long-term dual antiplatelet therapy group (p = 0.24). The findings were the same in various tested subgroups.
- Stent thrombosis: 0.1% vs. 0.1% (p = 0.99), respectively for short-term vs. long-term dual antiplatelet therapy
- Major bleeding: 0.7% vs. 0.7% (p = 0.99), respectively for short-term vs. long-term dual antiplatelet therapy
- From 6 months to 3 years, there was suggestion of enhanced benefit for long-term dual antiplatelet therapy among older patients with elevated SYNTAX score and among older patients with diabetes.
Among patients undergoing treatment with a biodegradable polymer drug-eluting stent, short-term dual antiplatelet therapy (6 months) was noninferior to long-term therapy (18 months). The incidence of all-cause mortality, myocardial infarction, stroke, or major bleeding was similar between treatment groups. Stent thrombosis was infrequent and occurred at a similar frequency between treatment groups. There was suggestion of enhanced benefit for long-term dual antiplatelet therapy among those with increased risk.
Presented by Dr. Masato Nakamura at the European Society of Cardiology Congress, Barcelona, Spain, August 28, 2017.
Nakamura M, Iijima R, Ako J, et al. Dual Antiplatelet Therapy for 6 Versus 18 Months After Biodegradable Polymer Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2017;10:1189-98.
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