Introduction
Methods
Discussion
Longer Is Better
Study | Total N (DES) | Stent types | Clinical diagnosis | DAPT duration | Endpoint | Follow-up duration (months) | Findings | |
---|---|---|---|---|---|---|---|---|
SA | ACS | |||||||
BASKET-LATE (ISRCTN75663024) [22] | 746 (545) | BMS, DES | 42.3% | 57.7% | 7–18 m | Cardiac death or MI | 18 | Discontinuation of clopidogrel between 7 and 18 months after PCI: DES 4.9% vs. BMS 1.3% |
Duke registry [23] | 4,666 (1,501) | BMS, DES | 12 m | Cardiac death or MI | 24 | Discontinuation of clopidogrel at 12 months after PCI vs. continuation: 4.5% vs. 0% (p < 0.001) | ||
Dutch registry [24] | 1,303 (418) | BMS, DES | 27.2% | 72.8% | 6–12 m | ST | 31 | Discontinuation of clopidogrel between 6 and 12 months after PCI: HR 5.87 (p = 0.004) |
Melbourne registry [25] | 2,980 (1,669) | BMS, DES | 38.5% | 61.5% | <6 vs. ≥12 m | All-cause death | 12 | 5.3% vs. 2.8%, p = 0.012 |
SWEDEHEART registry (NCT01623700) [26] | 42,268 (9,138) | BMS, DES, no stent | 0.0% | 100.0% | >6 m | All-cause death, MI or CVA | 12 | Adjusted HR 0.75, p = 0.0155 |
Shorter Is Better
Study | Total N (DES) | Stent types | Clinical diagnosis | DAPT duration | Endpoint | Follow-up duration (months) | Findings | |
---|---|---|---|---|---|---|---|---|
SA | ACS | |||||||
Registry data | ||||||||
Airoldi et al. [4] | 3,021 | SES, PES | 6 m | ST | 18 | Discontinuation of clopidogrel within 6 months vs. after 6 months of PCI: HR 13.74 (p < 0.001) vs. HR 0.94 (p = 0.92) | ||
Munich registry [5] | 6,816 | SES, PES | 65.0% | 35.0% | 6 m | ST | 48 | Discontinuation of clopidogrel within 6 months after PCI: significantly associated with ST (p < 0.001) |
TYCOON [27] | 897 (447) | BMS, DES | 12 vs. 24 m | ST, cardiac death, TVR or MI | 48 | 3% vs. 0.4% of ST (p = 0.02) 2% vs. 2% of cardiac death (p = 0.74) 2% vs. 0.4% of MI (p = 0.30) | ||
Randomized trials | ||||||||
ZEST-LATE (NCT00590174)/REAL-LATE (NCT00484926) [17] | 2,701 | SES, PES, ZES | 37.6% | 62.4% | 12 vs. 24 m | Cardiac death or MI | 24 | 1.8% vs. 1.2% (p = 0.17) |
PRODIGY (NCT00611286) [20] | 2,013 (1,497) | BMS, PES, EES, ZES, no stent | 25.6% | 74.4% | 6 vs. 24 m | All-cause death, MI or CVA | 24 | 10.0% vs. 10.1% (p = 0.91) Significantly high risk for bleeding in the 24-month group |
EXCELLENT (NCT00698607) [16] | 1,443 | SES, EES | 48.4% | 51.6% | 6 vs. 12 m | TVF (cardiac death, MI or TVR) | 12 | 4.8% vs. 4.3% (p = 0.001 for noninferiority) Diabetic patients in 6 month group: TVF was significantly frequent (HR 3.16, 95% CI 1.42–7.03, p = 0.005) |
RESET (NCT01145079) [19] | 2,117 | E-ZES | 45.4% | 54.6% | 3 vs. 12 m | Cardiac death, MI, ST, TVR or bleeding | 12 | 4.7% vs. 4.7% (p < 0.001 for noninferiority) |
OPTIMIZE (NCT01113372) [21] | 3,119 | ZES | 68.2% | 31.9% | 3 vs. 12 m | All-cause death, MI, CVA or bleeding | 12 | 6.0% vs. 5.8% (p = 0.02 for noninferiority) |
Observational Studies
Randomized Trials
Ongoing Randomized Trials
Study | Total N (DES) | Stent types | DAPT duration | Follow-up duration (months) | Primary endpoint |
---|---|---|---|---|---|
DAPT (NCT00977938) [32] | 20,645 | BMS, DES | 12 vs. 30 m | 30 | All-cause death, MI or CVA |
ISAR-SAFE (NCT00661206) [33] | 6,000 | DES | 6 vs. 12 m | 15 | All-cause death, MI, ST, CVA or bleeding |
OTIDUAL (NCT00822536) [34] | 3,120 | ZES | 3 vs. 12 m | 36 | Nonfatal MI, CVA or bleeding |
ARCTIC (NCT00827411) [35] | 2,500 | DES | 12 vs. >12 m | 18–30 | All-cause death, MI, ST, CVA or urgent revascularization |
EDUCATE (NCT01069003) | 2,500 | ZES | 12 vs. 30 m | 24–36 | Incidence of cardiac death, MI, ST, bleeding and DAPT compliance |
GLOBAL-LEADERS (NCT01813435) | 16,000 | Conventional DAPT 12 m vs. ticagrelor | 24 | All-cause death or MI | |
ISAR-CAUTION [36] | 3,000 | DES | Abrupt vs. tapered interruption | 3 | Cardiac death, MI, ST, CVA, bleeding or rehospitalization due to ACS |
SMART-DATE (NCT01701453) | 3,000 | New-generation DES | 6 vs. 12 m | 18 | All-cause death, MI, CVA, ST or bleeding |
SECURITY (NCT00944333) | 4,000 | Second generation DES | 6 vs. 12 m | 24 | Definite or probable ST between 6–24 m |
NIPPON (NCT01514227) | 4,598 | Biolimus A9 stent | 6 vs. 18 m | 18 | All-cause death, MI, CVA or bleeding |
REDUCE (NCT02118870) | 1,500 | Combo stent | 3 vs. 12 m | 12 | All-cause death, MI, CVA or bleeding |
DAPT-STEMI (NCT01459627) | 1,100 | DES | 6 vs. 12 m | 24 | All-cause death, MI, CVA, bleeding or any revascularization |