1. DAPT
Trial design: Patients undergoing DES/BMS PCI, no ischemic/bleeding complications, and with documented compliance at 1 year, were randomized to receive another 18 months of dual antiplatelet therapy (DAPT) or placebo. Patients were followed for 18 months.
Results
(p < 0.001)
(p = 0.72)
DES PCI: MACCE for DAPT vs. placebo: 4.3% vs. 5.9%, p < 0.001; MI: 2.1% vs. 4.1%, p < 0.001; stent thrombosis: 0.4% vs. 1.4%, p < 0.001; all-cause mortality: 2.0% vs. 1.5%, p = 0.05; GUSTO moderate/severe bleeding: 2.5% vs. 1.6%, p = 0.001
BMS PCI: MACCE for DAPT vs. placebo: 4.0% vs. 4.7%, p = 0.72; MI: 2.7% vs. 3.1%, p = 0.74; stent thrombosis: 0.5% vs. 1.1%, p = 0.24; all-cause mortality: 1% vs. 1.2%, p = 0.83 % %
Conclusions
Prolonged DAPT ~30 months following DES PCI results in lower stent thrombosis/recurrent MIs compared with 12-month DAPT, although bleeding and all-cause mortality were higher; BMS subset showed a less impressive treatment effect
Unclear to what extent this trial will immediately impact clinical practice; further follow-up and data from other ongoing trials are awaited
MACCE
DAPT DES PCI
(n = 5,020)
Placebo DES PCI
(n = 4,941)
DAPT BMS PCI
(n = 842)
Placebo BMS PCI
(n = 845)
Mauri L, et al. N Engl J Med 2014;371: