Journal ArticleDOI
Duration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents
Seung-Jung Park,Duk-Woo Park,Young-Hak Kim,Soo Jin Kang,Seung-Whan Lee,Cheol Whan Lee,Ki Hoon Han,Seong Wook Park,Sung Cheol Yun,Sang-Gon Lee,Seung-Woon Rha,In Whan Seong,Myung Ho Jeong,Seung Ho Hur,Nae Hee Lee,Junghan Yoon,Joo Young Yang,Bong Ki Lee,Young Jin Choi,Wook Sung Chung,Do-Sun Lim,Sang Sig Cheong,Kee Sik Kim,Jei Keon Chae,Deuk Young Nah,Doo-Soo Jeon,Ki Bae Seung,Jae-Sik Jang,Hun Sik Park,Keun Seok Lee +29 more
TLDR
The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infarction or death from cardiac causes.Abstract:
Background The potential benefits and risks of the use of dual antiplatelet therapy beyond a 12-month period in patients receiving drug-eluting stents have not been clearly established. Methods In two trials, we randomly assigned a total of 2701 patients who had received drugeluting stents and had been free of major adverse cardiac or cerebrovascular events and major bleeding for a period of at least 12 months to receive clopidogrel plus aspirin or aspirin alone. The primary end point was a composite of myocardial infarction or death from cardiac causes. Data from the two trials were merged for analysis. Results The median duration of follow-up was 19.2 months. The cumulative risk of the primary outcome at 2 years was 1.8% with dual antiplatelet therapy, as compared with 1.2% with aspirin monotherapy (hazard ratio, 1.65; 95% confidence interval [CI], 0.80 to 3.36; P = 0.17). The individual risks of myocardial infarction, stroke, stent thrombosis, need for repeat revascularization, major bleeding, and death from any cause did not differ significantly between the two groups. However, in the dual-therapy group as compared with the aspirin-alone group, there was a nonsignificant increase in the composite risk of myocardial infarction, stroke, or death from any cause (hazard ratio, 1.73; 95% CI, 0.99 to 3.00; P = 0.051) and in the composite risk of myocardial infarction, stroke, or death from cardiac causes (hazard ratio, 1.84; 95% CI, 0.99 to 3.45; P = 0.06). CONCLUSIONS The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infarction or death from cardiac causes. These findings should be confirmed or refuted through larger, randomized clinical trials with longer-term follow-up. (ClinicalTrials.gov numbers, NCT00484926 and NCT00590174.)read more
Citations
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ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation
Stefan James,Dan Atar,Luigi P. Badano,Carina Blomström Lundqvist,Michael A. Borger,Anthony H. Gershlick,Kurt Huber,Peter Jüni,Mattie J. Lenzen,Kenneth W. Mahaffey,Marco Valgimigli +10 more
TL;DR: The once-in-a-lifetime treatment with Abciximab Intracoronary for acute coronary syndrome and a second dose intravenously for atrial fibrillation is recommended for adults with high blood pressure.
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2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
Stephan Windecker,Philippe Kolh,Fernando Alfonso,Jean-Philippe Collet,Jochen Cremer,Volkmar Falk,Gerasimos Filippatos,Christian W. Hamm,Stuart J. Head,Peter Jüni,A. Pieter Kappetein,Adnan Kastrati,Juhani Knuuti,Ulf Landmesser,Günther Laufer,Franz-Josef Neumann,Dimitrios J. Richter,Patrick Schauerte,Miguel Sousa Uva,Giulio G. Stefanini,David P. Taggart,Lucia Torracca,Marco Valgimigli,William Wijns,Adam Witkowski +24 more
TL;DR: Neumann et al. as discussed by the authors proposed a task force to evaluate the EACTS Review Co-ordinator's work on gender equality in the context of women's reproductive health.
Journal ArticleDOI
Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial
Willem Dewilde,Tom Oirbans,Freek W.A. Verheugt,Johannes C. Kelder,Bart J.G.L. de Smet,Jean-Paul R. Herrman,Tom Adriaenssens,Mathias Vrolix,A. A. C. M. Heestermans,Marije M. Vis,Jan G. P. Tijsen,Arnoud W. van 't Hof,Jurriën M. ten Berg +12 more
TL;DR: Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events.
Journal ArticleDOI
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Glenn N. Levine,Eric R. Bates,John A. Bittl,Ralph G. Brindis,Stephan D. Fihn,Lee A. Fleisher,Christopher B. Granger,Richard A. Lange,Michael J. Mack,Laura Mauri,Roxana Mehran,Debabrata Mukherjee,L. Kristin Newby,Patrick T. O'Gara,Marc S. Sabatine,Peter K. Smith,Sidney C. Smith +16 more
TL;DR: Jonathan L. Halperin, MD, FACC, FAHA, Chair Glenn N. Levine, MD; Sana M. Al-Khatib,MD; and Lesley H. Curtis, PhD, PhD are the current members of the FACC/FAHA Board of Directors.
Journal ArticleDOI
Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting A Randomized Multicenter Trial
Marco Valgimigli,Gianluca Campo,Monia Monti,Pascal Vranckx,Gianfranco Percoco,Carlo Tumscitz,Fausto Castriota,Federico Colombo,Matteo Tebaldi,Giuseppe Fucà,Moh'd Kubbajeh,Elisa Cangiano,Monica Minarelli,Antonella Scalone,Caterina Cavazza,Alice Frangione,Marco Borghesi,Jlenia Marchesini,Giovanni Parrinello,Roberto Ferrari +19 more
TL;DR: In this paper, the authors evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration-approved drug-eluting or bare-metal stents.
References
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Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis
Christoph Stettler,Christoph Stettler,Simon Wandel,Sabin Allemann,Adnan Kastrati,Marie Claude Morice,Albert Schömig,Matthias Pfisterer,Gregg W. Stone,Martin B. Leon,José Suárez de Lezo,Jean-Jacques Goy,Seung-Jung Park,Manel Sabaté,Maarten J. Suttorp,Henning Kelbæk,Christian Spaulding,Maurizio Menichelli,Paul Vermeersch,Maurits T. Dirksen,Pavel Cervinka,Anna Sonia Petronio,Alain J Nordmann,Peter Diem,Bernhard Meier,Marcel Zwahlen,Stephan Reichenbach,Sven Trelle,Stephan Windecker,Peter Jüni,Peter Jüni +30 more
TL;DR: A network meta-analysis with a mixed-treatment comparison method to combine direct within-trial comparisons between stents with indirect evidence from other trials while maintaining randomisation found sirolimus-eluting stents seem to be clinically better than bare-metal and paclitaxel-eluted stents.
Journal ArticleDOI
Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents.
Matthias Pfisterer,Hans-Peter Brunner-La Rocca,Peter Buser,Peter Rickenbacher,Patrick Hunziker,Christian Mueller,Raban Jeger,Franziska Bader,Stefan Osswald,Christoph Kaiser,Basket-Late Investigators +10 more
TL;DR: After the discontinuation of clopidogrel, the benefit of DES in reducing target vessel revascularization is maintained but has to be balanced against an increase in late cardiac death or nonfatal MI, possibly related to late stent thrombosis.
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