This study compared 6 vs 12 or more months of dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) receiving contemporary DES, and it did not find differences in combined endpoint. However, looking at primary endpoint components separately, there were more infarctions in patients with a short DAPT scheme that we cannot ignore.
Prolonging antiaggregation in ACS patients with no excessive risk of bleeding should continue to be the standard treatment according to the SMART-DATE, presented at the American College of Cardiology 2018 scientific sessions, simultaneously published in Lancet.
The study randomized 2712 patients undergoing acute myocardial infarction with and without ST elevation or unstable angina receiving everolimus, zotarolimus or biolimus DES.
Patients receiving 6-month DAPT presented a similar combined endpoint rate (all cause death, MI or stroke) at 18 months follow-up compared to those receiving at least 12-month DAPT (4.7% vs 4.2%; HR 1.13) reaching a non-inferior criterion for this population (p=0.027).
With no differences in death or stroke between branches, there was a significantly higher rate of MI in patients under a short scheme (1.8% vs 0.8%; CI 95% 1.15-5.05) that was not compensated by a slight reduction in bleeding.
Read also: DAPT after PCI with EES: 6 or 12 Months?
It is worth noting that, among other things, only 73.7% of patients randomized to the short scheme complied with the protocol, so crossover was important. Also, clopidogrel was used in 80% of cases, seeing that the new antiaggregants were not available in South Korea at study kickoff.
Original title: 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial.
Reference: Hahn J-Y et al. Lancet. 2018; Epub ahead of print.
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