Document Detail


Benefit of long-term dual anti-platelet therapy in patients treated with drug-eluting stents: from the NHLBI dynamic registry.
MedLine Citation:
PMID:  23211356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal duration of dual-antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an important, unanswered question. This study was designed to evaluate the association of varying durations of DAPT on clinical outcomes after DES implantation for the treatment of coronary artery disease. Using the National Heart, Lung, and Blood Institute Dynamic Registry, patients enrolled in the last 2 waves after index percutaneous coronary intervention with DES and who were event free at the time of landmark analysis were included. Landmark analysis was performed 12 and 24 months after percutaneous coronary intervention, and patients were stratified according to continued use of DAPT or not. Subjects were evaluated for rates of death, myocardial infarction, and stent thrombosis at 4 years from their index procedures. The numbers of evaluable patients were 2,157 and 1,918 for the 12- and 24-month landmarks, respectively. In both landmark analyses, there was a significantly lower 4-year rate of death or myocardial infarction in the group that continued DAPT compared to the group that did not (12 months: 10.5% vs 14.5%, p = 0.01; 24 months: 5.7% vs 8.6%, p = 0.02). Beneficial differences in the group that continued on DAPT were preserved after multivariate and propensity adjustment. There were no significant differences in definite stent thrombosis in either landmark analysis. In conclusion, at 12 and 24 months after DES implantation, continued use of DAPT was associated with lower 4-year risk for death and myocardial infarction.
Authors:
Suresh R Mulukutla; Oscar C Marroquin; Helen A Vlachos; Faith Selzer; Catalin Toma; Kevin E Kip; J Dawn Abbott; Elizabeth Holper; Joon S Lee; Sameer Khandhar; Michael Kutcher; Sheryl Kelsey; Conrad Smith; David Faxon; David O Williams
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-12-01
Journal Detail:
Title:  The American journal of cardiology     Volume:  111     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-04     Completed Date:  2013-04-15     Revised Date:  2014-02-18    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  486-92     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Antineoplastic Agents, Phytogenic / pharmacology
Aspirin / administration & dosage
Coronary Artery Disease / epidemiology,  therapy*
Dose-Response Relationship, Drug
Drug Therapy, Combination
Drug-Eluting Stents*
Follow-Up Studies
Humans
Immunosuppressive Agents / pharmacology
Paclitaxel / pharmacology
Percutaneous Coronary Intervention / methods*
Platelet Aggregation Inhibitors / administration & dosage*
Recurrence
Registries*
Retrospective Studies
Sirolimus / pharmacology
Survival Rate / trends
Ticlopidine / administration & dosage,  analogs & derivatives
Time Factors
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
HL-33292-12/HL/NHLBI NIH HHS; HL-33292-13/HL/NHLBI NIH HHS; HL-33292-14/HL/NHLBI NIH HHS; HL-33292-15/HL/NHLBI NIH HHS; HL-33292-16/HL/NHLBI NIH HHS; HL-33292-17/HL/NHLBI NIH HHS; HL-33292-18/HL/NHLBI NIH HHS; HL-33292-19/HL/NHLBI NIH HHS; HL-33292-20/HL/NHLBI NIH HHS; HL-33292-21/HL/NHLBI NIH HHS; HL-33292-22/HL/NHLBI NIH HHS; U01 HL033292/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antineoplastic Agents, Phytogenic; 0/Immunosuppressive Agents; 0/Platelet Aggregation Inhibitors; 33069-62-4/Paclitaxel; A74586SNO7/clopidogrel; OM90ZUW7M1/Ticlopidine; R16CO5Y76E/Aspirin; W36ZG6FT64/Sirolimus
Comments/Corrections

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