Zotarolimus stent outcomes unaffected by duration of antiplatelet therapy
MedWire News: Clinical outcomes are not affected by the duration of antiplatelet treatment among patients who have undergone revascularization with zotarolimus-eluting stents (ZES), researchers report.
In particular, extended dual antiplatelet therapy beyond 6 months is not associated with a significant reduction in cardiovascular death, myocardial infarction (MI), or stent thrombosis (ST), report David Kandzari (Piedmont Heart Institute, Atlanta, Georgia, USA) and colleagues.
"These findings merit further, definitive investigation regarding the 'optimal' duration of dual antiplatelet therapy to characterize the balance of risk and benefit in addition to whether dual antiplatelet therapy requirements differ according to drug-eluting stent (DES) type," they add, in the Journal of the American College of Cardiology: Cardiovascular Interventions.
Kandzari and team performed a pooled analysis of 1414 patients enrolled in five trials who underwent percutaneous coronary revascularization with ZES. All patients were event-free (events defined as all-cause and cardiac mortality, MI, stroke, and ST) and receiving dual antiplatelet therapy (aspirin and thienopyridine) at 6 months after ZES implantation.
Outcome comparisons were performed relative to dual antiplatelet therapy duration at 6, 12, or 24 months.
After 3 years of follow-up there was no significant difference in the risk-adjusted composite outcome of mortality, MI, stroke, and ST, nor in its individual components, between patients who were on dual antiplatelet therapy for 6 months and those receiving it for 12 months or more.
Furthermore, major bleeding events were negligible across both groups, the researchers note.
"The appropriate duration of aspirin and thienopyridine therapy remains undefined," say Kandzari et al.
In a related commentary, editorialists Adnan Kastrati, Robert Byrne, and Stefanie Schulz from the Technische Universität in Munich, Germany write: "Optimal dual antiplatelet treatment duration after DES will still be guided by a careful assessment of the balance between the risk for ST and the likelihood of bleeding events at an individual patient level."
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By Piriya Mahendra