Comparison of the 9-month intra-stent conditions and 2-year clinical outcomes after Resolute zotarolimus-eluting stent implantation between 3-month and standard dual antiplatelet therapy. Issue 1 (July 2018)

• Record Type: Journal Article
• Authors: Fujimoto, Wataru; Sawada, Takahiro; Toba, Takayoshi; Takahashi, Yu; Miyata, Taishi; Oishi, Shogo; Osue, Tsuyoshi; Onishi, Tetsuari; Takaya, Tomofumi; Shimane, Akira; Taniguchi, Yasuyo; Kawai, Hiroya; Yasaka, Yoshinori
• Is Part Of: Journal of cardiology. Volume 72:Issue 1(2018)
• Page Start: 66
• Page End: 73
• Publication Date: 2018-07
• Subjects: Short dual-antiplatelet therapy -- Optical coherence tomography -- Resolute zotarolimus-eluting stent; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2018.01.006
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: Arterial healing after stenting is not influenced by dual antiplatelet therapy (DAPT) duration. The prevalence of abnormal intra-stent tissue (AIT) is not associated with DAPT duration. Malapposition at 9 months is the strongest predictor of AIT at 9 months. Cardiac events were equal, although major bleeding was higher in the standard group. Abstract: Background: The use of short-duration dual antiplatelet therapy (DAPT) remains controversial. To investigate efficacy and safety of short-duration DAPT, we performed a detailed comparison of intra-stent conditions by optical coherence tomography (OCT) after second-generation drug-eluting stent implantation with short-term and standard DAPT. Methods and results: Eighty-two consecutive patients with stable angina pectoris who received Resolute zotarolimus-eluting stents (R-ZESs; Medtronic Cardiovascular, Santa Rosa, CA, USA) were enrolled. Patients were assigned to 3-month (3M group: 41 patients) and standard (standard group: 41 patients) DAPT. In the 3M group, clopidogrel was discontinued 3 months after stent implantation. In the standard group, DAPT was maintained until follow-up OCT. At 9 months, neointimal proliferation was significantly larger in the 3M group, but there were no significant between-group differences in the proportion of uncovered and malapposed strut. The prevalence of abnormal intra-stent tissue (AIT) at 9 months was equivalent between groups. A multiple regression analysis revealed malapposition at 9 months as the strongest independent predictor of AIT at 9 months, and the prevalence of AIT was not associated with DAPT duration. Over 2 years, cardiac events were equal between groups; however, major bleeding was higher tendency in the standard group than in the 3M group. Conclusion: This OCT study indicated that reducing DAPT's duration may provide acceptable arterial healing in patients with implanted R-ZESs.