Dual Antiplatelet Therapy Beyond 1-year after Percutaneous Coronary Interventions for Stable Coronary Artery Disease Results in Harm  

The benefit of extended dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. The ARTIC-Interruption Trial examined discontinuation of DAPT at 1-year after PCI vs continuation for an additional 6-18 months. The study randomized patients 1-year after PCI to continuation (N=635) or interruption (N=624) groups, and examined the primary composite endpoint of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization over a median follow-up of 17 months. No significant differences were observed between the treatment groups for the primary outcome (hazard ratio [HR] 1.17; 95% confidence interval [CI] 0.68–2.03]; p=0.58). Bleeding events (as defined by STEEPLE criteria) occurred significantly more frequently in the continuation group (HR 0.26; 95% CI 0.07–0.91; p=0.04) when major and minor bleeding events were combined. As this study was a follow on to an evaluation of antiplatelet regimens guided by platelet reactivity at the time of index PCI, there was variation in the type of DAPT between patients at randomization for this study. Furthermore, there was crossover between treatment arms that was not evaluated with an on-treatment analysis.

Conclusion: These results add to a growing body of literature suggesting harm with extended DAPT beyond 1-year after PCI in the absence of recurrent ischemic events in the year following PCI.

           

Summarized by Jehu S. Mathew and Steven M. Bradley

 

Collet JP, Silvain J, Barthelemy O, Range G, Cayla G, Van Belle E, Cuisset T, Elhadad S, Schiele F, Lhoest N, Ohlmann P, Carrie D, Rousseau H, Aubry P, Monsegu J, Sabouret P, O’Connor SA, Abtan J, Kerneis M, Saint-Etienne C, Beygui F, Vicaut E, Montalescot G, for the Ai. Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (arctic-interruption): A randomised trial. Lancet. 2014 Jul 15. pii: S0140-6736(14)60612-7. doi: 10.1016/S0140-6736(14)60612-7. [Epub ahead of print]