Cardiology News / Recent Literature Review / Second Quarter 2015

Abstract

ESC Congress : London, 29/8-2/9/2015 TCT Meeting 2015: San Francisco, 11-15/10/2015 HCS Congress: Thessaloniki, 29-31/10/2015 AHA Scientific Sessions: Orlando, 7-11/11/2015 DAPT Study: Continuation of Dual Antiplatelet Therapy After PCI in Patients With and Without Acute Myocardial Infarction Beyond 1 Year Reduced Ischemic Events, but Increased Bleeding Compared With Treatment With Aspirin Alone Among 11,648 randomized patients (9,961 treated with drug-eluting stents, 1,687 with bare-metal stents), 30.7% presenting with MI, between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs 1.9%, p< 0.001; no MI group, 0.4% vs. 1.1%, p< 0.001). The reduction in major adverse cardiovascular and cerebrovascular events (MACCE) for continued thienopyridine was greater for patients with MI (3.9% vs 6.8%; p< 0.001 for MI; 4.4% vs 5.3%; p= 0.08 for no MI). In both groups, continued thienopyridine reduced MI (2.2% vs 5.2%, p< 0.001 for MI; 2.1% vs 3.5%, p< 0.001 for no MI) but increased bleeding (1.9% vs 0.8%, p= 0.005 for MI; 2.6% vs 1.7%, p= 0.007 for no MI). The authors concluded that extended dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, but increased bleeding (Yeh RW et al, J Am Coll Cardiol 2015;65:2211-2221). Metaanalysis: Dual Antiplatelet Therapy (DAPT) is Associated With Protection Against Stent Thrombosis but Increases Risk of Bleeding in Patients With Drug Eluting Stents (DES) / Benefit of Extended DAPT for Patients With First-Generation DES, but not for Second-Generation DES Metaanalysis of 10 randomized controlled trials (N = 32,135) indicated that compared to longer duration DAPT (L-DAPT; mean exposure time 20.3 months for second-generation DES and 28 months for first-generation DES), shorter duration DAPT (S-DAPT; mean exposure time 7.8 months for second-generation DES and 10.9 months for first-generation DES) had an overall higher rate of stent thrombosis (odds ratio - OR: 1.71; p = 0.001). The effect of S-DAPT on stent thrombosis was attenuated with the use of second-generation DES (OR: 1.54) compared with first-generation DES (OR: 3.94; p for interaction = 0.008). S-DAPT had an overall significantly lower risk of bleeding (OR: 0.63; p < 0.001). Finally, a numerically lower all-cause mortality rate was observed with S-DAPT (OR: 0.87; p = 0.073). The authors concluded that S-DAPT had overall lower rates of bleeding yet higher rates of stent thrombosis compared with L-DAPT; the latter effect was significantly attenuated with the use of second-generation DES. All-cause mortality was higher (not statistically) with L-DAPT (Giustino G et al, J Am Coll Cardiol 2015;65:1298-1310)... (excerpt)