1. A randomised comparison of coronary stents according to short or prolonged durations of dual antiplatelet therapy in patients with acute coronary syndromes: a pre-specified analysis of the SMART-DATE trial
- Author
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Hyeon-Cheol Gwon, Woo Jin Jang, Jin-Ok Jeong, Woo Jung Chun, Young Bin Song, Seung-Hyuk Choi, Jin Bae Lee, Ik Hyun Park, Ki Hong Choi, Joo-Yong Hahn, Ju Hyeon Oh, Jong-Seon Park, and Joon-Hyung Doh
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,medicine.medical_treatment ,Stent ,medicine.disease ,Percutaneous Coronary Intervention ,Treatment Outcome ,Clinical Research ,Drug-eluting stent ,Internal medicine ,Absorbable Implants ,Durable polymer ,medicine ,Clinical endpoint ,Cardiology ,Humans ,Stents ,Treatment effect ,In patient ,Myocardial infarction ,Acute Coronary Syndrome ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
BACKGROUND: Data on direct comparison between various drug-eluting stents with short duration dual antiplatelet therapy (DAPT) are limited, especially in patients with acute coronary syndrome (ACS). AIMS: We sought to compare biodegradable polymer biolimus-eluting stents (BP-BES) with durable polymer everolimus-eluting (DP-EES) and zotarolimus-eluting stents (DP-ZES) in patients with ACS according to different durations of DAPT. METHODS: In the SMART-DATE trial, 2,712 patients with ACS underwent randomisation for allocation of DAPT (6 months [n=1,357] or 12 months or longer [n=1,355]) and type of stent (BP-BES [n=901]), DP-EES [n=904], or DP-ZES [n=907]). The primary endpoint was a composite of cardiac death, myocardial infarction, or stent thrombosis. RESULTS: At 18 months, the primary endpoint was attained by 2.6% with BP-BES, 2.0% with DP-EES, and 2.1% with DP-ZES (HR 1.29, 95% CI: 0.70-2.39, p=0.42 for BP-BES vs DP-EES and HR 1.23, 95% CI: 0.67-2.26, p=0.50 for BP-BES vs DP-ZES). The treatment effect of BP-BES for the primary endpoint was consistent among patients receiving 6-month DAPT as well as those receiving 12-month or longer DAPT (BP-BES vs. DP-EES, pinteraction=0.48 and BP-BES vs DP-ZES, pinteraction=0.87). After excluding 179 patients (101 in the BP-BES group) who did not receive allocated DES, the per-protocol analysis showed similar results. CONCLUSIONS: The risk of a composite of cardiac death, myocardial infarction, or stent thrombosis was not significantly different between patients receiving BP-BES versus DP-EES or DP-ZES across a short or prolonged duration of DAPT after ACS.
- Published
- 2021
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