Should duration of dual antiplatelet therapy depend on the type and/or potency of implanted stent? A pre-specified analysis from the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY).

Abstract

AIMS:

The purpose of this pre-specified analysis of the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY) was to assess device-specific outcomes relative to different duration of dual antiplatelet therapy (DAPT) after Everolimus- (EES), Paclitaxel (PES), Zotarolimus- (ZES-S) eluting, or bare metal stents (BMS).

METHODS AND RESULTS:

We randomized 2013 patients to BMS, ZES-S, PES, or EES implantation. At 30 days, each stent group underwent up to 6 or 24 months clopidogrel therapy. The primary endpoint, which was a composite of death, myocardial infarction, or cerebrovascular accident, did not differ in patients receiving BMS [HR: 0.89 (95% CI: 0.54-1.45)], PES [HR: 0.74 (95% CI: 0.43-1.25)], or EES [HR: 0.63 (95% CI: 0.33-1.21)] implantation across DAPT groups, whereas it was significantly higher in ZES-S patients undergoing long when compared with short-term DAPT therapy (HR: 2.85, P = 0.0018), with positive interaction testing (P-value = 0.004). At the 6-month landmark analysis, heterogeneity across stent types persisted for the primary study endpoint and other secondary clinical outcomes, whereas patients receiving PES showed a significantly higher rate of definite, probable and definite, probable, possible stent thrombosis in the short DAPT regimen. No association in absolute or relative terms was noted between stent potency in inhibiting intimal hyperplasia and greater vulnerability to shorter DAPT therapy.

CONCLUSION:

Our study suggests that optimal duration of DAPT may be stent-specific and it does not support a clear association between stent potency and vulnerability to shorter DAPT therapy. Trial Registration clinicaltrials.gov Identifier: NCT00611286. http://clinicaltrials.gov/ct2/show/NCT00611286?term=prodigy&rank=2.

• Authors: Marco Valgimigli, Marco Borghesi, Matteo Tebaldi, Pascal Vranckx, Giovanni Parrinello, Roberto Ferrari, PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY Investigators
• Journal: European heart journal (Eur Heart J) Vol. 34 Issue 12 Pg. 909-19 (Mar 2013) ISSN: 1522-9645 [Electronic] England
• PMID: 23315904 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Platelet Aggregation Inhibitors
• Everolimus
• Clopidogrel
• zotarolimus
• Ticlopidine
• Sirolimus

Topics

• Aged
• Clopidogrel
• Coronary Restenosis (pathology, prevention & control)
• Coronary Vessels (pathology)
• Drug Administration Schedule
• Drug Therapy, Combination
• Drug-Eluting Stents (adverse effects)
• Everolimus
• Female
• Graft Occlusion, Vascular (prevention & control)
• Humans
• Hyperplasia (etiology)
• Male
• Myocardial Infarction (etiology)
• Platelet Aggregation Inhibitors (administration & dosage)
• Sirolimus (administration & dosage, analogs & derivatives)
• Stents (adverse effects)
• Stroke (etiology)
• Ticlopidine (administration & dosage, analogs & derivatives)
• Tunica Intima (pathology)