• David E Kandzari, Colin S Barker, Martin B Leon, Laura Mauri, William Wijns, Jean Fajadet, and Roxana Mehran.
• Department of Interventional Cardiology, Piedmont Heart Institute, Suite 300, 275 Collier Road, Atlanta, Georgia 30309, USA. david.kandzari@piedmont.org
• JACC Cardiovasc Interv. 2011 Oct 1; 4 (10): 1119-28.

ObjectivesWe sought to evaluate differences in late safety outcomes relative to dual antiplatelet therapy (DAPT) duration in patients treated with zotarolimus-eluting stents (ZES).BackgroundDespite treatment recommendations for at least 12 months of DAPT following drug-eluting stent revascularization, device-specific outcomes relative to DAPT duration are absent.MethodsAmong 2,032 patients undergoing percutaneous coronary revascularization with ZES in 5 trials, late safety events were compared relative to DAPT duration for patients with ≥ 6 months DAPT adherence and survival free of major ischemic and bleeding events.ResultsA total of 1,414 event-free patients on DAPT at 6 months were identified. Patient group comparisons relative to DAPT included: 6 months versus ≥ 12 months, and 6 months versus ≥ 24 months. Through 3 years, risk-adjusted ischemic event rates did not significantly differ between groups: 6 versus ≥ 12 months: death (2.7% vs. 2.2%), myocardial infarction (MI, 0.3% vs. 1.1%), and definite/probable stent thrombosis (ST, 0.3% vs. 0%); 6 versus ≥ 24 months: death (1.6% vs. 1.6%), MI (0.4% vs. 1.2%), and definite/probable ST (0.1% vs. 0.2%). Composite events also did not statistically vary between DAPT durations. In multivariable analysis, 6-month versus longer DAPT duration was not associated with increased likelihood of thrombotic events at 3-year follow-up. Major bleeding was negligible across groups.ConclusionsAmong patients treated with ZES, late-term events of death, MI, stroke, and ST do not significantly differ between patients taking 6 months DAPT compared with continuation beyond 1 year. These findings merit further study to identify the appropriate duration of DAPT according to specific drug-eluting stents.Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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