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Article Dans Une Revue Clinical Cardiology Année : 2016

Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation.

Jean-Philippe Collet
  • Fonction : Auteur
Johanne Silvain
  • Fonction : Auteur
Mathieu Kerneis
  • Fonction : Auteur
Nicolas Meneveau
  • Fonction : Auteur
Ziad Boueri
  • Fonction : Auteur
Olivier Barthélémy
  • Fonction : Auteur
Grégoire Rangé
Guillaume Cayla
  • Fonction : Auteur
Eric Belle
  • Fonction : Auteur
Simon Elhadad
  • Fonction : Auteur
Didier Carrié
  • Fonction : Auteur
Christophe Caussin
  • Fonction : Auteur
Hélène Rousseau
  • Fonction : Auteur
Pierre Aubry
  • Fonction : Auteur
Jacques Monségu
  • Fonction : Auteur
Pierre Sabouret
Stephen A O'Connor
  • Fonction : Auteur
Jérémie Abtan
  • Fonction : Auteur
Christophe Saint-Etienne
  • Fonction : Auteur
Farzin Beygui
  • Fonction : Auteur
Eric Vicaut
Gilles Montalescot

Résumé

There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)-Generation assessed whether there is a difference of outcome between first- vs second-generation DES and if there is an interaction with DAPT duration in the ARCTIC-Interruption study. ARCTIC-Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first- and a second-generation DES, respectively. After a median follow-up of 17 months (interquartile range, 15-18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first- and second-generation DES, respectively (hazard ratio: 2.31, 95% confidence interval: 1.31-4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first- and second-generation DES, respectively (hazard ratio: 1.79, 95% confidence interval: 0.40-8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC-Generation showed worse clinical outcome with first- vs second-generation DES, a difference that appeared to persist even with prolonged DAPT.
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Dates et versions

hal-01478197 , version 1 (27-02-2017)

Identifiants

  • HAL Id : hal-01478197 , version 1
  • PUBMED : 26880570

Citer

Jean-Philippe Collet, Johanne Silvain, Mathieu Kerneis, Thomas Cuisset, Nicolas Meneveau, et al.. Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation.. Clinical Cardiology, 2016, pp.192-200. ⟨hal-01478197⟩
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