Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents

作者：Laura Mauri, Dean J. Kereiakes, Robert W. Yeh, Priscilla Driscoll-Shempp, Donald E. Cutlip, Philippe Gabríel Steg, Sharon‐Lise T. Normand, Eugene Braunwald, Stephen D. Wiviott, David J. Cohen, David R. Holmes, Mitchell W. Krucoff, James Hermiller, Harold L. Dauerman, Daniel I. Simon, David E. Kandzari, Kirk N. Garratt, David P. Lee, Thomas Pow, Peter Ver Lee, Michael J. Rinaldi, Joseph M. Massaro · 发表于：New England Journal of Medicine · 年份：2014 · DOI：10.1056/nejmoa1409312 · 被引用次数：1914 · 研究领域：Coronary Interventions and Diagnostics、Antiplatelet Therapy and Cardiovascular Diseases、Peripheral Artery Disease Management

BACKGROUND: Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain. METHODS: Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a thienopyridine drug (clopidogrel or prasugrel) and aspirin, patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving aspirin. The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial infarction, or stroke) during the period from 12 to 30 months. The primary safety end point was moderate or severe bleeding. RESULTS: A total of 9961 patients were randomly assigned to continue thienopyridine treatment or to receive placebo. Continued treatment with thienopyridine, as compared with placebo, reduced the rates of stent thrombosis (0.4% vs. 1.4%; hazard ratio, 0.29 [95% confidence interval {CI}, 0.17 to 0.48]; P<0.001) and major adverse cardiovascular and cerebrovascular events (4.3% vs. 5.9%; hazard ratio, 0.71 [95% CI, 0.59 to 0.85]; P<0.001). The rate of myocardial infarction was lower with thienopyridine treatment than with placebo (2.1% vs. 4.1%; hazard ratio, 0.47; P<0.001). The rate of death from any cause was 2.0% in the group that continued thien...