DES bests BMS with 1 month of DAPT

  • Shah R & al.
  • JAMA Cardiol
  • 1 Nov 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Drug-eluting stents (DESs) best bare-metal stents (BMSs) with only 1 month of dual antiplatelet therapy (DAPT) for risk for major adverse cardiac events (MACE), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR).
  • Authors of this meta-analysis of 3 randomized controlled trials (RCTs) suggest DESs should be “default” when likelihood of DAPT adherence past 1 month is questionable.

Why this matters

  • Accompanying editorial says DESs used in 2 trials probably attenuated apparent benefit, and BMS has no role with short-term DAPT with high bleeding risk.
  • A second editorial says RCT data are needed to confirm safety of short-term DAPT with DES.

Key results

  • With DES vs BMS, reduced 1-year rates of (ORs; 95% CIs):
    • MACE: 0.68 (0.57-0.82; P<.001>
    • MI: 0.51 (0.31-0.83; P=.01);
    • TVR: 0.50 (0.38-0.65; P<.001 and>
    • TLR: 0.38 (0.22-0.67; P=.001).
    • Stent thrombosis: 1.8% vs 2.8% (significant in 1 model: P=.045).
  • DES and BMS did not differ for: 
    • All-cause mortality: 0.87 (0.70-1.08; P=.21);
    • Cardiac mortality: 0.84 (0.63-1.11; P=.22); or 
    • Bleeding: 0.84 (0.66-1.08; P=.20).

Study design

  • Meta-analysis, subgroup data, 3 RCTs (n=3943), DES or BMS, and 1-month DAPT.
  • Endpoints: 1-year all-cause/cardiac mortality, TLR, TVR, MI, MACE, stent thrombosis, bleeding.
  • Funding: None disclosed.

Limitations

  • Lack of contemporary, durable-polymer DESs.

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