• Media type: E-Article
  • Title: Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting : A Randomized Multicenter Trial : A Randomized Multicenter Trial
  • Contributor: Valgimigli, Marco; Campo, Gianluca; Monti, Monia; Vranckx, Pascal; Percoco, Gianfranco; Tumscitz, Carlo; Castriota, Fausto; Colombo, Federico; Tebaldi, Matteo; Fucà, Giuseppe; Kubbajeh, Moh'd; Cangiano, Elisa; Minarelli, Monica; Scalone, Antonella; Cavazza, Caterina; Frangione, Alice; Borghesi, Marco; Marchesini, Jlenia; Parrinello, Giovanni; Ferrari, Roberto
  • Published: Ovid Technologies (Wolters Kluwer Health), 2012
  • Published in: Circulation, 125 (2012) 16, Seite 2015-2026
  • Language: English
  • DOI: 10.1161/circulationaha.111.071589
  • ISSN: 0009-7322; 1524-4539
  • Origination:
  • Footnote:
  • Description: 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.
  • Access State: Open Access