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Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial.

Abstract：

BACKGROUND:The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined. We 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. METHODS AND RESULTS:We randomly assigned 2013 patients to receive bare-metal, zotarolimus-eluting, paclitaxel-eluting, or everolimus-eluting stent implantation. At 30 days, patients in each stent group were randomly allocated to receive up to 6 or 24 months of clopidogrel therapy in addition to aspirin. The primary end point was a composite of death of any cause, myocardial infarction, or cerebrovascular accident. The cumulative risk of the primary outcome at 2 years was 10.1% with 24-month dual-antiplatelet therapy compared with 10.0% with 6-month dual-antiplatelet therapy (hazard ratio, 0.98; 95% confidence interval, 0.74-1.29; P=0.91). The individual risks of death, myocardial infarction, cerebrovascular accident, or stent thrombosis did not differ between the study groups; however, there was a consistently greater risk of hemorrhage in the 24-month clopidogrel group according to all prespecified bleeding definitions, including the recently proposed Bleeding Academic Research Consortium classification. CONCLUSIONS:A regimen of 24 months of clopidogrel therapy in patients who had received a balanced mixture of drug-eluting or bare-metal stents was not significantly more effective than a 6-month clopidogrel regimen in reducing the composite of death due to any cause, myocardial infarction, or cerebrovascular accident. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.

journal_name

Circulation

journal_title

Circulation

authors

Valgimigli M,Campo G,Monti M,Vranckx P,Percoco G,Tumscitz C,Castriota F,Colombo F,Tebaldi M,Fucà G,Kubbajeh M,Cangiano E,Minarelli M,Scalone A,Cavazza C,Frangione A,Borghesi M,Marchesini J,Parrinello G,Ferrari R,P

doi

10.1161/CIRCULATIONAHA.111.071589

subject

Has Abstract

pub_date

2012-04-24 00:00:00

pages

2015-26

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.111.071589

journal_volume

125

pub_type

杂志文章,多中心研究,随机对照试验

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Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial.