Stent Thrombosis and Dual Antiplatelet Therapy Interruption with Everolimus-Eluting Stents: Insights from the Xience v Coronary Stent System Trials

Philippe Généreux, David R. Rutledge, Tullio Palmerini, Adriano Caixeta, Elvin Kedhi, James B. Hermiller, Jin Wang, Mitchell W. Krucoff, Jennifer Jones-McMeans, Krishnankutty Sudhir, Charles A. Simonton, Patrick W. Serruys, Gregg W. Stone

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background - Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. Methods and Results - Outcomes from 11 219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75%) occurred in 83 patients during 2 years, with 41 (48.2%) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63%] versus 58/7152 [0.83%] respectively; P=0.27]. By propensity and DAPT usage-adjusted multivariable analysis, permanent DAPT discontinuation before 30 days was independently associated with the occurrence of ST (hazard ratio [95% confidence interval], 26.8 [8.4-85.4]; P<0.0001), whereas permanent DAPT discontinuation in any interval after 90 days was not associated with ST. Only 2 ST events occurred after DAPT discontinuation between 30 and 90 days (both between 30 and 60 days), and the association between permanent DAPT discontinuation and ST during this period is unclear (hazard ratio [95% confidence interval], 8.7 [2.0-37.3]; P=0.004 for adjusted analysis and 3.4 [0.8-13.8]; P=0.07 for the unadjusted analysis). Conclusions - In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe.

Original languageEnglish (US)
Article numbere001362
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number5
DOIs
StatePublished - May 20 2015

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Stents
Thrombosis
Chromium
Cobalt
Therapeutics
Everolimus
Confidence Intervals
Registries

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Généreux, Philippe ; Rutledge, David R. ; Palmerini, Tullio ; Caixeta, Adriano ; Kedhi, Elvin ; Hermiller, James B. ; Wang, Jin ; Krucoff, Mitchell W. ; Jones-McMeans, Jennifer ; Sudhir, Krishnankutty ; Simonton, Charles A. ; Serruys, Patrick W. ; Stone, Gregg W. / Stent Thrombosis and Dual Antiplatelet Therapy Interruption with Everolimus-Eluting Stents : Insights from the Xience v Coronary Stent System Trials. In: Circulation: Cardiovascular Interventions. 2015 ; Vol. 8, No. 5.
@article{969bf8f954734909944418d572e708b6,
title = "Stent Thrombosis and Dual Antiplatelet Therapy Interruption with Everolimus-Eluting Stents: Insights from the Xience v Coronary Stent System Trials",
abstract = "Background - Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. Methods and Results - Outcomes from 11 219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75{\%}) occurred in 83 patients during 2 years, with 41 (48.2{\%}) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63{\%}] versus 58/7152 [0.83{\%}] respectively; P=0.27]. By propensity and DAPT usage-adjusted multivariable analysis, permanent DAPT discontinuation before 30 days was independently associated with the occurrence of ST (hazard ratio [95{\%} confidence interval], 26.8 [8.4-85.4]; P<0.0001), whereas permanent DAPT discontinuation in any interval after 90 days was not associated with ST. Only 2 ST events occurred after DAPT discontinuation between 30 and 90 days (both between 30 and 60 days), and the association between permanent DAPT discontinuation and ST during this period is unclear (hazard ratio [95{\%} confidence interval], 8.7 [2.0-37.3]; P=0.004 for adjusted analysis and 3.4 [0.8-13.8]; P=0.07 for the unadjusted analysis). Conclusions - In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe.",
author = "Philippe G{\'e}n{\'e}reux and Rutledge, {David R.} and Tullio Palmerini and Adriano Caixeta and Elvin Kedhi and Hermiller, {James B.} and Jin Wang and Krucoff, {Mitchell W.} and Jennifer Jones-McMeans and Krishnankutty Sudhir and Simonton, {Charles A.} and Serruys, {Patrick W.} and Stone, {Gregg W.}",
year = "2015",
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doi = "10.1161/CIRCINTERVENTIONS.114.001362",
language = "English (US)",
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Généreux, P, Rutledge, DR, Palmerini, T, Caixeta, A, Kedhi, E, Hermiller, JB, Wang, J, Krucoff, MW, Jones-McMeans, J, Sudhir, K, Simonton, CA, Serruys, PW & Stone, GW 2015, 'Stent Thrombosis and Dual Antiplatelet Therapy Interruption with Everolimus-Eluting Stents: Insights from the Xience v Coronary Stent System Trials', Circulation: Cardiovascular Interventions, vol. 8, no. 5, e001362. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001362

Stent Thrombosis and Dual Antiplatelet Therapy Interruption with Everolimus-Eluting Stents : Insights from the Xience v Coronary Stent System Trials. / Généreux, Philippe; Rutledge, David R.; Palmerini, Tullio; Caixeta, Adriano; Kedhi, Elvin; Hermiller, James B.; Wang, Jin; Krucoff, Mitchell W.; Jones-McMeans, Jennifer; Sudhir, Krishnankutty; Simonton, Charles A.; Serruys, Patrick W.; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 8, No. 5, e001362, 20.05.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stent Thrombosis and Dual Antiplatelet Therapy Interruption with Everolimus-Eluting Stents

T2 - Insights from the Xience v Coronary Stent System Trials

AU - Généreux, Philippe

AU - Rutledge, David R.

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Kedhi, Elvin

AU - Hermiller, James B.

AU - Wang, Jin

AU - Krucoff, Mitchell W.

AU - Jones-McMeans, Jennifer

AU - Sudhir, Krishnankutty

AU - Simonton, Charles A.

AU - Serruys, Patrick W.

AU - Stone, Gregg W.

PY - 2015/5/20

Y1 - 2015/5/20

N2 - Background - Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. Methods and Results - Outcomes from 11 219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75%) occurred in 83 patients during 2 years, with 41 (48.2%) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63%] versus 58/7152 [0.83%] respectively; P=0.27]. By propensity and DAPT usage-adjusted multivariable analysis, permanent DAPT discontinuation before 30 days was independently associated with the occurrence of ST (hazard ratio [95% confidence interval], 26.8 [8.4-85.4]; P<0.0001), whereas permanent DAPT discontinuation in any interval after 90 days was not associated with ST. Only 2 ST events occurred after DAPT discontinuation between 30 and 90 days (both between 30 and 60 days), and the association between permanent DAPT discontinuation and ST during this period is unclear (hazard ratio [95% confidence interval], 8.7 [2.0-37.3]; P=0.004 for adjusted analysis and 3.4 [0.8-13.8]; P=0.07 for the unadjusted analysis). Conclusions - In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe.

AB - Background - Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. Methods and Results - Outcomes from 11 219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75%) occurred in 83 patients during 2 years, with 41 (48.2%) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63%] versus 58/7152 [0.83%] respectively; P=0.27]. By propensity and DAPT usage-adjusted multivariable analysis, permanent DAPT discontinuation before 30 days was independently associated with the occurrence of ST (hazard ratio [95% confidence interval], 26.8 [8.4-85.4]; P<0.0001), whereas permanent DAPT discontinuation in any interval after 90 days was not associated with ST. Only 2 ST events occurred after DAPT discontinuation between 30 and 90 days (both between 30 and 60 days), and the association between permanent DAPT discontinuation and ST during this period is unclear (hazard ratio [95% confidence interval], 8.7 [2.0-37.3]; P=0.004 for adjusted analysis and 3.4 [0.8-13.8]; P=0.07 for the unadjusted analysis). Conclusions - In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe.

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