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.
Description:
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.
Study Design
- Randomized
- Parallel
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%
Inclusion criteria:
- 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
Exclusion criteria:
- In-stent restenosis
- Treatment of saphenous vein graft or left main lesion
Principal Findings:
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.
Secondary outcomes:
- 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.
Interpretation:
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.
References:
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.
Keywords: ESC2017, ESC Congress, Acute Coronary Syndrome, Angina, Stable, Anticoagulants, Diabetes Mellitus, Drug-Eluting Stents, Hemorrhage, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Polymers, Saphenous Vein, Stents, Stroke, Thrombosis
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