Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type.
Details
Serval ID
serval:BIB_D7C64E85BFF3
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type.
Journal
European Heart Journal
Working group(s)
PROTECT Steering Committee, Investigators
Contributor(s)
Camenzind E., Mauri L., O'Neill W., Serruys PW., Steg P., Wijns W., Verheugt F., Bertrand M., Califf R., DeMets D., Wallentin L., Bocksch W., Bosmans J., Garcia H., Garg S., Hanet C., Herrman JP., Kelbaek H., Mc Fadden E., Radke P., Rutsch W., Tilsted H., Wykrzykowska J., Alvarez C., Rodriguez A., Meredith I., Muller D., Whitbourn R., Worthley S., Whelan A., Walters D., Shetty S., New G., Cox S., Batra R., van Gaal W., Bellamy G., Mayr H., Heigert M., Huber K., Leisch F., Wijns W., Desmet W., Boland J., Schroeder E., Chenu P., Legrand V., Labinaz M., Teefy P., Bertrand O., Gao R., Ge J., Kala P., Cervinka P., Ureña P., Hartikainen J., Steg G., Fajadet J., Carrie D., Gilard M., Barragan P., Lablanche JM., Koning R., Eltchaninoff H., Darremont O., Leroy F., Bertrand B., Robert G., Schiele F., Chassaing S., Bressollette E., Brunel P., Quilliet L., Brunet J., Pansieri M., Sideris G., Stratiev V., Teiger E., Lebreton H., Bonnet JL., Karsenty B., Delarche N., Lusson JR., Cassagnes J., Brachmann J., Kurowski V., Buerke M., Schieffer B., Scholtz W., Wiemer M., Fichtlscherer S., Schächinger V., Kupatt C., Boekstegers P., Genth-Zotz S., Bode C., Frey N., Neumann FJ., Witzenbichler B., Pels K., Strasser R., Kuck KH., Hauptmann KE., Baldus S., Heitzer T., Haude M., Hoffmann E., Jung W., Hoffmann S., Schmitt C., Dissmann M., Pauschinger M., Werner G., Braun-Delleus R., Burkhardt D., Manz M., Voudris V., Sionis D., Kang-Yin ML., Tse TS., Merkely B., Mehta A., Parikh K., Kumar V., Chandra P., Rath P., Hiremath S., Crean P., Daly K., Kornowski R., Kerner A., Mosseri M., Jafari G., Giudice P., Trani C., Manari A., Prati F., Pangrazi A., Bolognese L., Jeong MH., Kim MY., Kim HS., Park SJ., Erglis A., Kalnins A., Wagner D., Zambahari R., Ong TK., Sim K., den Heijer P., Appelman Y., Suttorp MJ., de Smet B., Koolen J., Stella P., Harding S., Warwick J., Maslowski A., Abernethy M., Devlin G., Rotevatn S., Myreng Y., Ciecwierz D., Peruga J., Reczuch K., Campante Teles R., Farto P., Abreu E., Leitão-Marques A., Pereira H., Vinereanu D., Alkasab S., Mhish H., Al Kurdi M., Al Turki F., Wong P., Teo SG., Goicolea Ruigomez FJ. , Valdés Chávarri M., Bethencourt Gonzalez A., Iñiguez Romo A., López Minguez J., Hernández García JM. , Diaz Fernández J., Ruiz Salmeron R., Martinez Elbal L., Zueco J., López-Palop R., Melgares R., Diderholm E., Kåregren A., Herterich O., Olivencrona G., Fröbert O., Roffi M., Verin V., Girod G., Vuilliomenet A., Hsieh IC., Wu CJ., Gershlick A., Densem C., Doshi S., Manoharan G., McCarthy P., De Belder M., Mills J., Fath-Ordoubadi F., Simpson I., Greenwood J., Chamberlain-Webber R., Khan Z., Cotton J., Gunning M., Smith D., Talwar S., Holmberg S., Purcell I., Anderson R., Alamgir F., Beatt K., Kelly P., Moussavian M., Aji J., Prashad R., Zankar A., Banerjee S., Lewis S., McLaurin B., Douglas J., Brener S., Gupta A., Walters L., Driesman M., Aycock R., Mego C., Fisher D., Frankel R., Satler L.
ISSN
1522-9645 (Electronic)
ISSN-L
0195-668X
Publication state
Published
Issued date
2014
Volume
35
Number
29
Pages
1932-1948
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish. Grégoire Girod fait partie de PROTECT Steering CommitteeInvestigators
Abstract
AIM: 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).
METHODS AND RESULTS: 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 (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43).
CONCLUSION: 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).
METHODS AND RESULTS: 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 (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43).
CONCLUSION: 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).
Pubmed
Web of science
Open Access
Yes
Create date
12/08/2014 14:49
Last modification date
20/08/2019 16:57
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