Differential Impacts of Coronary Stent Type and Duration of DAPT

The type of stent partially influences the risk of adverse cardiovascular events when different dual antiplatelet therapy (DAPT) durations are prescribed, according to a study published August 11 in the European Heart Journal. However, when not considering duration of DAPT, durable and biodegradable polymer stents along with bioresorbable scaffolds (BRS) have a similar rate of major adverse cardiovascular events (MACE) defined as death, myocardial infarction and target vessel revascularization.

Using a network meta-analysis of 64 randomized controlled trials and 102,735 patients, Fabrizio D’Ascenzo, et al., compared the different types of drug-eluting stents (DES) and durations of DAPT. The primary endpoint was MACE and the secondary endpoints were definite stent thrombosis and the individual MACE components.

The arms of interest for the study were stents with DAPT duration less than 12 months, stents with DAPT duration lasting 12 months and stents with DAPT greater than 12 months; there were 150 arms of interest. The results focused on the comparison among BRS, polymer biodegradable stents and second-generation DES – everolimus-eluting stent (EES) and zotarolimus-eluting stent (ZES) – with different DAPT durations.

After a median follow-up of 20 months, the rates of MACE were similar across the different arms of interest. Of note, there was a lower incidence of myocardial infarction with EES and ZES for a duration of DAPT greater than 12 months vs. all other groups. Also, there was a higher rate of stent thrombosis with a BRS compared with EES and ZES, regardless of the DAPT duration. A higher risk for major bleeding was seen for a DAPT duration greater than 12 months vs. a shorter duration.

No differences were observed in terms of target lesion revascularization, target vessel revascularization and death among the different combinations of stent and DAPT duration.

“Despite the large amount of data evaluated in our analysis, its results should be interpreted carefully and in light of some important considerations,” the study authors write. “Half of the patients included were admitted for acute coronary syndrome (ACS): while for selected patients with stable coronary artery disease a shortened DAPT could represent a safe choice, in patients with ACS a shortened DAPT may lead to a higher rate of adverse events.”

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Drug-Eluting Stents, Coronary Artery Disease, Acute Coronary Syndrome, omega-Chloroacetophenone, Incidence, Follow-Up Studies, Absorbable Implants, Sirolimus, Myocardial Infarction, Stents, Polymers, Thrombosis

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