Prolonged vs Short Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With or Without Peripheral Arterial Disease
Key result
Prolonged DAPT reduces major events ~46% vs short DAPT in PCI patients with PAD.
- HR 0.54
- 95% CI 0.31-0.95
- P=0.03
- n=1,970
Why the study?
Does prolonged dual antiplatelet therapy (24 months) reduce ischemic events compared to short duration (≤6 months) in patients with or without peripheral arterial disease undergoing percutaneous coronary intervention?
Population
1,970 unselected patients from tertiary care hospitals with stable coronary artery disease or acute coronary…
Comparison
Prolonged dual antiplatelet therapy for 24 months vs Short dual antiplatelet therapy for ≤6 months
Design
RCT, Randomized (subanalysis of the PRODIGY trial)
Authors
Discussion
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Implication
Supports prolonged DAPT after PCI in patients with PAD; extends prior duration trials to this high-risk subgroup with ischemic benefit.
Study Design
Type
RCT (n=1,970)
Randomization
randomized
Multicenter
Yes
Structured PICO
Does prolonged dual antiplatelet therapy (24 months) reduce ischemic events compared to short duration (≤6 months) in patients with or without peripheral arterial disease undergoing percutaneous coronary intervention?
P
Population
1,970 unselected patients from tertiary care hospitals with stable coronary artery disease or acute coronary syndromes undergoing percutaneous coronary intervention, stratified by the presence (n=246) or absence (n=1724) of concomitant peripheral arterial disease.
I
Intervention
Prolonged dual antiplatelet therapy (DAPT) for 24 months
C
Comparator
Short dual antiplatelet therapy (DAPT) for ≤6 months
O
Outcome
Composite of death, myocardial infarction, or cerebrovascular accidentscomposite
Main Result
Effect estimate: HR 0.54 (95% CI 0.31-0.95)
Absolute Event Rate: 16.1% vs 27.3%
p-value: p=0.03
Prolonged dual antiplatelet therapy (24 months) significantly reduces ischemic events without increasing bleeding risk in the high-risk subgroup of patients with peripheral arterial disease undergoing PCI.
Cite This Study
Franzone et al. (2016) conducted an RCT in stable coronary artery disease or acute coronary syndromes with or without peripheral arterial disease undergoing PCI (n=1,970). Prolonged dual antiplatelet therapy (DAPT) vs. Short dual antiplatelet therapy (DAPT) was evaluated on composite of death, myocardial infarction, or cerebrovascular accidents (HR 0.54, 95% CI 0.31-0.95, p=0.03). Prolonged DAPT lowered the risk of death, MI, or cerebrovascular accidents vs short DAPT in PCI patients with PAD (16.1% vs 27.3%; HR 0.54; 95% CI 0.31-0.95; P=0.03).