Coronary interventions

Optimal dual antiplatelet therapy duration for bioresorbable scaffolds: an individual patient data pooled analysis of the ABSORB trials

EuroIntervention 2021;17:e981-e988. DOI: 10.4244/EIJ-D-21-00263

Lorenzo Azzalini
Lorenzo Azzalini1, MD, PhD, MSc; Stephen G. Ellis2, MD; Dean J. Kereiakes3, MD; Takeshi Kimura4, MD; Runlin Gao5, MD; Yoshinobu Onuma6, MD, PhD; Bernard Chevalier7, MD; Ovidiu Dressler8, MD; Aaron Crowley8, MA; Zhipeng Zhou8, MA; Björn Redfors8,9,10, MD, PhD; Patrick W. Serruys11,12, MD, PhD; Gregg W. Stone8,13, MD
1. Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA; 2. Cleveland Clinic, Cleveland, OH, USA; 3. The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, OH, USA; 4. Kyoto University Graduate School of Medicine, Kyoto, Japan; 5. Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China; 6. Erasmus Medical Center, Rotterdam, the Netherlands; 7. Institut Cardiovasculaire Paris Sud, Massy, France; 8. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 9. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; 10. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; 11. Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland; 12. Department of Cardiology, Imperial College of London, London, United Kingdom; 13. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Background: Compared with everolimus-eluting metallic stents, the Absorb bioresorbable scaffold (BRS) results in increased rates of myocardial infarction (MI) and scaffold thrombosis (ST) during its three-year bioresorption phase. It is unknown whether prolonged dual antiplatelet therapy (DAPT) duration might decrease the risk of ischaemic events.

Aims: We sought to evaluate the impact of DAPT duration on ischaemic and bleeding outcomes following BRS implantation.

Methods: We conducted an individual patient data pooled analysis from four ABSORB randomised trials and one prospective ABSORB registry. Study endpoints were MI, ST, bleeding, and death up to three-year follow-up. Propensity score-adjusted Cox regression analysis was used to account for baseline differences related to DAPT duration.

Results: The five ABSORB studies included 2,973 patients. DAPT use was 91.7%, 53.2%, and 48.0% at 1, 2, and 3 years, respectively. DAPT use within the first year after BRS implantation was associated with markedly lower risks of MI (adjusted hazard ratio [aHR] 0.17, 95% CI: 0.10-0.32; p<0.0001) and ST (aHR 0.08, 95% CI: 0.03-0.19; p<0.0001). Conversely, DAPT use between 1 and 3 years did not significantly affect the risk of MI (aHR 1.04, 95% CI: 0.70-1.55; p=0.84) or ST (aHR 0.86, 95% CI: 0.42-1.75; p=0.67). DAPT did not have major effects upon bleeding or death in either period.

Conclusions: DAPT use during the first year after BRS implantation was strongly associated with lower risks of ST and MI. However, a benefit of ongoing DAPT use between 1 and 3 years after BRS implantation was not apparent.

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bioresorbable scaffoldsstent thrombosisclinical trialsadjunctive pharmacotherapy
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