Clinical Outcome of First‐ vs Second‐Generation DES According to DAPT Duration: Results of ARCTIC‐Generation

• Published in: Clinical Cardiology
• Main Authors: Collet, Jean‐Philippe, Silvain, Johanne, Kerneis, Mathieu, Cuisset, Thomas, Meneveau, Nicolas, Boueri, Ziad, Barthélémy, Olivier, Rangé, Grégoire, Cayla, Guillaume, Belle, Eric Van, Elhadad, Simon, Carrié, Didier, Caussin, Christophe, Rousseau, Hélène, Aubry, Pierre, Monségu, Jacques, Sabouret, Pierre, O'Connor, Stephen A., Abtan, Jérémie, Saint‐Etienne, Christophe, Beygui, Farzin, Vicaut, Eric, Montalescot, Gilles
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2016
• Subjects: Arctic; Stent
• Online Access: http://dx.doi.org/10.1002/clc.22512; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fclc.22512; https://onlinelibrary.wiley.com/doi/pdf/10.1002/clc.22512

ABSTRACT There is an apparent benefit with extension of dual antiplatelet therapy ( DAPT ) beyond 1 year after implantation of drug‐eluting stents ( DES ). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring‐Guided Strategy for Drug‐Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting ( ARCTIC )‐Generation assessed whether there is a difference of outcome between first‐ vs second‐generation DES and if there is an interaction with DAPT duration in the ARCTIC ‐Interruption study. ARCTIC ‐Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first‐ and a second‐generation DES , respectively. After a median follow‐up of 17 months (interquartile range, 15–18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first‐ and second‐generation DES , respectively (hazard ratio: 2.31, 95% confidence interval: 1.31‐4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first‐ and second‐generation DES , respectively (hazard ratio: 1.79, 95% confidence interval: 0.40‐8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC ‐Generation showed worse clinical outcome with first‐ vs second‐generation DES , a difference that appeared to persist even with prolonged DAPT .