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Suggestion for Use of Triple Antiplatelet Therapy According to Stent Length: Results from Pooled Analysis of DECLARE Trials
APRIL 23e26, 2013
Antithrombotics Wednesday, April 24, 2013 2:00 PM w 6:00 PM (Abstract nos. AS-132, AS-133) - AS-132 Suggestion for Use of Triple Antiplatelet Therapy According to Stent Length: Results from Pooled Analysis of DECLARE Trials. Seung-Whan Lee. Asan Medical Center, Seoul, Korea (Republic of). Background: The aim of this study was to find most beneficial patients from triple antiplatelet therapy based on association between the length of the stented segment and the risk of angiographic restenosis after drug-eluting stent (DES) implantation. Although triple antiplatelet therapy showed restenosis and repeat revascularization in complex coronary lesions after DES implantation, no practical guideline to use triple antiplatelet therapy was suggested. Methods: Pooled analysis of three randomized studies in patients with DM (DECLARE-DIABETES) and long lesion (DECLARE-LONG I and II) compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol, triple group, n¼700) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n¼699) receiving sirolimus- (SES), paclitaxel- (PES), and zotarolimus-eluting stent (ZES). We analyzed follow-up angiographic outcomes. Results: All patients (n¼1399) were divided into 6 categories (£20mm, 20 to 30mm, 30 to 40mm, 40 to 50mm, 50 to 60mm, >60 mm) according to stent length. In-stent restenosis rate was significantly diverged in 40 to 50 mm group (9.4% vs. 24.2%, p¼0.005) and 50 to 60 mm category (6.0% vs. 20.3%, p¼0.012) between triple and standard group. If lesions were divided into 3 category (£2.5mm, 2.5 to 3.0 mm, >3.0mm) according to post-procedural minimal lumen diameter (MLD), triple group showed lower in-stent restenosis compared to standard group in all categories.
Conclusion: Triple group after DES significantly reduced restenosis in stent length ranging from 40 mm to 60 mm, compared to standard group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.
- AS-133 Impact of Triple Antiplatelet Therapy on Angiographic Restenosis After Drug-eluting Stents: Results from Pooled Analysis of DECLARE Trials. Seung-Whan Lee, Jeong Yoon Jang, Gyung-Min Park, Young-Rak Cho, Jung-Min Ahn, Jong-Young Lee, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Young-Hak Kim, Cheol-Whan Lee, Seung-Jung Park. Asan Medical Center, Seoul, Korea (Republic of). Background: To assess impact of cilostazol on angiographic restenosis after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM) or long lesions. Restenosis after DES remains a significant clinical problem in complex coronary lesions. Methods: Pooled analysis of three randomized studies in patients with DM (DECLARE-DIABETES) and long lesion (DECLARE-LONG I and II) compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol, triple group, n¼700) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n¼699) receiving sirolimus- (SES), paclitaxel- (PES), and zotarolimus-eluting stent (ZES). We analyzed follow-up angiographic outcomes. Results: Triple group significantly reduced in-stent restenosis (8.2% vs. 13.6%; RR 0.60; 95% CI, 0.53-0.84, p<0.001) and in-segment (9.0% vs. 15.7%; RR 0.58, 95% CI, 0.53-0.65, p<0.001) compared to standard group. Impact of triple group on late loss for in-stent (absolute reduction; 0.11 to 0.13 mm, p for interaction¼0.97) and in-segment (absolute reduction; 0.13 to 0.15 mm, p for interaction¼0.75) was consistent across stent type. Impact of triple group on in-segment restenosis was most prominent in SES (0.5% vs. 6.7%; RR 0.08; 95% CI, 0.02-0.34, p<0.001) than PES (14.4% vs. 20.2%; RR 0.71; 95% CI, 0.708-0.714, p<0.001) or ZES (12.2% vs. 20.0%, RR 0.61; 95% CI, 0.39-0.96, p¼0.028). Conclusion: Triple group after DES significantly reduced restenosis by z40% compared to standard group in patients at high risk of restenosis. Triple group showed similar reduction of in-stent late loss by z0.12 mm regardless of stent type, which resulted in negligible restenosis rate (0.5%) in SES. Therefore, newer generation DES with performance comparable to SES might have prominent beneficial effect with triple therapy in term of angiographic restenosis.
P O S T E R A B S T R A C T S
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
65B
Antithrombotics Wednesday, April 24, 2013 2:00 PM w 6:00 PM (Abstract nos. AS-132, AS-133) - AS-132 Suggestion for Use of Triple Antiplatelet Therapy According to Stent Length: Results from Pooled Analysis of DECLARE Trials. Seung-Whan Lee. Asan Medical Center, Seoul, Korea (Republic of). Background: The aim of this study was to find most beneficial patients from triple antiplatelet therapy based on association between the length of the stented segment and the risk of angiographic restenosis after drug-eluting stent (DES) implantation. Although triple antiplatelet therapy showed restenosis and repeat revascularization in complex coronary lesions after DES implantation, no practical guideline to use triple antiplatelet therapy was suggested. Methods: Pooled analysis of three randomized studies in patients with DM (DECLARE-DIABETES) and long lesion (DECLARE-LONG I and II) compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol, triple group, n¼700) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n¼699) receiving sirolimus- (SES), paclitaxel- (PES), and zotarolimus-eluting stent (ZES). We analyzed follow-up angiographic outcomes. Results: All patients (n¼1399) were divided into 6 categories (£20mm, 20 to 30mm, 30 to 40mm, 40 to 50mm, 50 to 60mm, >60 mm) according to stent length. In-stent restenosis rate was significantly diverged in 40 to 50 mm group (9.4% vs. 24.2%, p¼0.005) and 50 to 60 mm category (6.0% vs. 20.3%, p¼0.012) between triple and standard group. If lesions were divided into 3 category (£2.5mm, 2.5 to 3.0 mm, >3.0mm) according to post-procedural minimal lumen diameter (MLD), triple group showed lower in-stent restenosis compared to standard group in all categories.
Conclusion: Triple group after DES significantly reduced restenosis in stent length ranging from 40 mm to 60 mm, compared to standard group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.
- AS-133 Impact of Triple Antiplatelet Therapy on Angiographic Restenosis After Drug-eluting Stents: Results from Pooled Analysis of DECLARE Trials. Seung-Whan Lee, Jeong Yoon Jang, Gyung-Min Park, Young-Rak Cho, Jung-Min Ahn, Jong-Young Lee, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Young-Hak Kim, Cheol-Whan Lee, Seung-Jung Park. Asan Medical Center, Seoul, Korea (Republic of). Background: To assess impact of cilostazol on angiographic restenosis after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM) or long lesions. Restenosis after DES remains a significant clinical problem in complex coronary lesions. Methods: Pooled analysis of three randomized studies in patients with DM (DECLARE-DIABETES) and long lesion (DECLARE-LONG I and II) compared triple antiplatelet therapy (aspirin, clopidogrel and cilostazol, triple group, n¼700) and dual antiplatelet therapy (aspirin and clopidogrel, standard group, n¼699) receiving sirolimus- (SES), paclitaxel- (PES), and zotarolimus-eluting stent (ZES). We analyzed follow-up angiographic outcomes. Results: Triple group significantly reduced in-stent restenosis (8.2% vs. 13.6%; RR 0.60; 95% CI, 0.53-0.84, p<0.001) and in-segment (9.0% vs. 15.7%; RR 0.58, 95% CI, 0.53-0.65, p<0.001) compared to standard group. Impact of triple group on late loss for in-stent (absolute reduction; 0.11 to 0.13 mm, p for interaction¼0.97) and in-segment (absolute reduction; 0.13 to 0.15 mm, p for interaction¼0.75) was consistent across stent type. Impact of triple group on in-segment restenosis was most prominent in SES (0.5% vs. 6.7%; RR 0.08; 95% CI, 0.02-0.34, p<0.001) than PES (14.4% vs. 20.2%; RR 0.71; 95% CI, 0.708-0.714, p<0.001) or ZES (12.2% vs. 20.0%, RR 0.61; 95% CI, 0.39-0.96, p¼0.028). Conclusion: Triple group after DES significantly reduced restenosis by z40% compared to standard group in patients at high risk of restenosis. Triple group showed similar reduction of in-stent late loss by z0.12 mm regardless of stent type, which resulted in negligible restenosis rate (0.5%) in SES. Therefore, newer generation DES with performance comparable to SES might have prominent beneficial effect with triple therapy in term of angiographic restenosis.
P O S T E R A B S T R A C T S
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
65B