Beneficial Impact of Prolonged Dual Antiplatelet Therapy after Drug‐Eluting Stent Implantation

Background: Twelve‐month dual antiplatelet therapy (DAT) with aspirin and clopidogrel after drug‐eluting stent (DES) implantation is routinely recommended. It is unclear if prolonged (>12‐month) DAT is also favorable. We compared the outcome of patients discontinuing DAT 12 months after off‐label DES implantation versus those with DAT for >12 months. Methods: Baseline, treatment, and outcome data of patients undergoing off‐label DES implantation and free from events 11.5 months after index procedure were retrospectively retrieved. Those discontinuing DAT between 11.5 and 12.5 months (12‐month DAT group) were compared to those discontinuing DAT after 12.5 months (>12‐month DAT group). The primary end‐point was the long‐term (>24‐month) rate of major adverse cerebro‐cardiovascular events (MACCE). Results: Two hundred seventy‐two patients met study inclusion criteria: 133 (48.9%) in the 12‐month DAT group and 139 (51.1%) in the >12‐month DAT group (who were on DAT for an average of 24 months). After an average of 36 months after DES implantation, 14 patients (5.1%) developed MACCE, with 6 (3.5%) cardiac deaths, 7 (2.2%) myocardial infarctions, no stroke, and 5 (1.8%) repeat revascularizations. The >12‐month DAT group had a significantly lower risk of MACCE (1 [0.7%] vs. 13 [9.8%] in the 12‐month DAT group, P < 0.001) and myocardial infarction (0 vs. 7 [5.3%], P = 0.006), with such differences confirmed at multivariable propensity‐adjusted analyses. No significant differences in terms of minor or major bleedings occurred. Conclusions: In this retrospective registry, patients with off‐label DES implantation receiving prolonged (>12 months) DAT presented with lower rates of MACCE and myocardial infarction. (J Interven Cardiol 2012;25:596–603)