Back to Search
Start Over
Impact of clinical presentation on ischaemic and bleeding outcomes in patients receiving 6- or 24-month duration of dual-antiplatelet therapy after stent implantation: a pre-specified analysis from the PRODIGY Prolonging Dual-Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia) trial
- Source :
- European Heart Journal; 5/21/2015, Vol. 36 Issue 20, p1242-1251, 10p, 2 Charts, 5 Graphs
- Publication Year :
- 2015
-
Abstract
- Aims. We investigated if acute coronary syndrome (ACS) rather than stable coronary artery disease (SCAD) presentation is an outcome modifier with respect to the duration of dual-antiplatelet therapy (DAPT) in patients undergoing coronary stenting. Methods and results. In the ProlongingDual-Antiplatelet TreatmentAfter Grading Stent-Induced IntimalHyperplasia (PRODIGY) trial, a total of 1465 (74.3%) patients presented ACSwhereas 505 (25.7%) had SCADandwere randomized to 6- or 24-monthDAPT. At 24 months, the composite of death, myocardial infarction (MI), or cerebrovascular accident (CVA) did not differ between the long- and short-term DAPT arms in both ACS (11.1 vs. 11.7%; P = 0.67) and SCAD (7.5 vs. 4.8%; P = 0.21) patients, respectively. Long-term DAPT was associated with a 75% increase of Bleeding Academic Research Consortium (BARC)-class 2, 3, or 5 bleeding in ACS [7.1 vs. 4.1%; hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.11-2.74, P = 0.015; number needed to treat for harm (NNTH): 33.3] and a five-fold increase in SCAD (8.2 vs. 1.6%; HR 5.37, 95% CI 1.84-15.74, P = 0.002; NNTH: 15.1) patients, with a borderline quantitative interaction (P<subscript>INT</subscript> = 0.056). As a result, net adverse cardiovascular events (death, MI, CVA, BARC class 2, 3, or 5 bleeding) were more than doubled in SCAD patients receiving 24-month DAPT, whereas they did not differ in ACS patients (P<subscript>INT</subscript> = 0.024). Conclusions. This analysis suggests that clinical presentation may be a treatment modifier with respect to DAPT duration after stenting consistent with the hypothesis that SCAD-but not ACS-patients are exposed to a significant increase in bleeding and net adverse clinical events when treated with 24-month compared with 6-month therapy. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 0195668X
- Volume :
- 36
- Issue :
- 20
- Database :
- Complementary Index
- Journal :
- European Heart Journal
- Publication Type :
- Academic Journal
- Accession number :
- 102939852
- Full Text :
- https://doi.org/10.1093/eurheartj/ehv038