Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type
European Heart Journal
Abstract
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).
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 (
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).
Contributors
Eric Boersma
Author
William Wijns
Author
Laura Mauri
Author
Tessa Rademaker-Havinga
Author
Farzin Fath Ordoubadi
Author
Maarten J. Suttorp
Author
Mohammad Al Kurdi
Author
Ph Gabriel Steg
Author
E Camenzind
Author
L Mauri
Author
W O'Neill
Author
P W Serruys
Author
PhG Steg
Author
W Wijns
Author
FWA Verheugt
Author
ME Bertrand
Author
R Califf
Author
D DeMets
Author
L Wallentin
Author
W Bocksch
Author
J Bosmans
Author
H Garcia
Author
S Garg
Author
C Hanet
Author
J-PR Herrman
Author
H Kelbaek
Author
E Mc Fadden
Author
PW Radke
Author
W Rutsch
Author
HH Tilsted
Author
J Wykrzykowska
Author
C Alvarez
Author
A Rodriguez
Author
I Meredith
Author
D Muller
Author
R Whitbourn
Author
S Worthley
Author
A Whelan
Author
D Walters
Author
S Shetty
Author
G New
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S Cox
Author
R Batra
Author
W van Gaal
Author
G Bellamy
Author
H Mayr
Author
M Heigert
Author
K Huber
Author
F Leisch
Author
W Wijns
Author
W Desmet
Author
J Boland
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E Schroeder
Author
P Chenu
Author
V Legrand
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M Labinaz
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P Teefy
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O Bertrand
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R Gao
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J Ge
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P Kala
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P Cervinka
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P Ureña
Author
J Hartikainen
Author
G Steg
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J Fajadet
Author
D Carrie
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M Gilard
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P Barragan
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J-M Lablanche
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R Koning
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H Eltchaninoff
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O Darremont
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F Leroy
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B Bertrand
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G Robert
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F Schiele
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S Chassaing
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E Bressollette
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P Brunel
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L Quilliet
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J Brunet
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M Pansieri
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G Sideris
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V Stratiev
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E Teiger
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H Lebreton
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J-L Bonnet
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B Karsenty
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N Delarche
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J-R Lusson
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J Cassagnes
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J Brachmann
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V Kurowski
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M Buerke
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B Schieffer
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W Scholtz
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M Wiemer
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S Fichtlscherer
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V Schächinger
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C Kupatt
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P Boekstegers
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S Genth-Zotz
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C Bode
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N Frey
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F-J Neumann
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B Witzenbichler
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K Pels
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R Strasser
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K-H Kuck
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K-E Hauptmann
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S Baldus
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T Heitzer
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M Haude
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E Hoffmann
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W Jung
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S Hoffmann
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C Schmitt
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M Dissmann
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M Pauschinger
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G Werner
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R Braun-Delleus
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D Burkhardt
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M Manz
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V Voudris
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D Sionis
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M-L Kang-Yin
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T-S Tse
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B Merkely
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A Mehta
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K Parikh
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V Kumar
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P Chandra
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P Rath
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S Hiremath
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P Crean
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K Daly
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R Kornowski
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A Kerner
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M Mosseri
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G Jafari
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P Giudice
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C Trani
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A Manari
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F Prati
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A Pangrazi
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L Bolognese
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M-H Jeong
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M-Y Kim
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H-S Kim
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S-J Park
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A Erglis
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A Kalnins
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D Wagner
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R Zambahari
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T-K Ong
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K Sim
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P den Heijer
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Y Appelman
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M-J Suttorp
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B de Smet
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J Koolen
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P Stella
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S Harding
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J Warwick
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A Maslowski
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M Abernethy
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G Devlin
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S Rotevatn
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Y Myreng
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H Pereira
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D Vinereanu
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S Alkasab
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H Mhish
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M Al Kurdi
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F Al Turki
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P Wong
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S-G Teo
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F-J Goicolea Ruigomez
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M Valdés Chávarri
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A Bethencourt Gonzalez
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A Iñiguez Romo
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J López Minguez
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J-M Hernández García
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J Diaz Fernández
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R Ruiz Salmeron
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L Martinez Elbal
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J Zueco
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RF López-Palop
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R Melgares
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E Diderholm
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A Kåregren
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O Herterich
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G Olivencrona
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O Fröbert
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M Roffi
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V Verin
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G Girod
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A Vuilliomenet
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I-C Hsieh
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C-J Wu
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A Gershlick
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C Densem
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G Manoharan
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P McCarthy
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M De Belder
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J Mills
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F Fath-Ordoubadi
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I Simpson
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J Greenwood
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R Chamberlain-Webber
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Z Khan
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J Cotton
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M Gunning
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D Smith
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S Talwar
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S Holmberg
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I Purcell
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R Anderson
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F Alamgir
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K Beatt
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P Kelly
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M Moussavian
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J Aji
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R Prashad
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A Zankar
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S Banerjee
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S Lewis
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B McLaurin
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L Satler
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