Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials.
Options
BORIS DOI
Publisher DOI
PubMed ID
29454730
Description
OBJECTIVES
This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients.
BACKGROUND
Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited.
METHODS
Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding.
RESULTS
The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196).
CONCLUSIONS
Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients.
BACKGROUND
Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited.
METHODS
Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding.
RESULTS
The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196).
CONCLUSIONS
Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
Date of Publication
2018-03-12
Publication Type
Article
Subject(s)
Keyword(s)
coronary artery disease drug-eluting stent(s) dual antiplatelet therapy
Language(s)
en
Contributor(s)
Lee, Seung-Yul | |
Hong, Myeong-Ki | |
Palmerini, Tullio | |
Kim, Hyo-Soo | |
Feres, Fausto | |
Colombo, Antonio | |
Gilard, Martine | |
Shin, Dong-Ho | |
Kim, Jung-Sun | |
Kim, Byeong-Keuk | |
Ko, Young-Guk | |
Choi, Donghoon | |
Jang, Yangsoo | |
Stone, Gregg W |
Additional Credits
Series
JACC. Cardiovascular Interventions
Publisher
Elsevier
ISSN
1876-7605
Access(Rights)
restricted