Short-duration dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with DES is growing steadily, especially for chronic coronary syndromes. There is also some evidence regarding its use in acute coronary syndrome.
However, diabetes is a well-known risk factor for both restenosis and thrombosis, since it involves more complex and longer lesions in vessels that are generally smaller in diameter.
Researchers conducted a subanalysis of randomized studies STOPDAPT-2 and STOP-DAPT-2ACS, comparing DAPT for 30 days with ASA 81 mg and clopidogrel, and then clopidogrel monotherapy vs. DAPT for 12 months.
This subanalysis included 5997 patients. Of these, 2030 had diabetes (33.8%) and 3967 did not.
The primary endpoint (PEP) was a composite of cardiovascular events and bleeding. The former comprised cardiovascular death, infarction, stroke, and definite stent thrombosis. The second included major and minor bleeding according to TIMI criteria.
As regards diabetic patients, 60.9% received pharmacological treatment and 14.1%, insulin.
After 12 months of follow-up, there were no differences neither in the PEP (3.58% for 1-month DAPT vs. 4.12% for 12-month DAPT; hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.56-1.37; p = 0.55) nor for cardiovascular death (3.02 vs. 3.5; p = 0.7). However, those who received DAPT for 30 days experienced less bleeding compared with those who received it for 12 months (0.30% vs. 1.50% [HR: 0.20; 95% CI: 0.06 to 0.68; p = 0.01).
Clopidogrel as monotherapy after 1 month with DAPT, compared with 12 months of DAPT, reduced major bleeding without an increase in cardiovascular events independent of diabetes. These findings should be considered hypothesis-generating, especially in patients with acute coronary syndromes, as the results from the STOPDAPT -2 ACS Study are inconclusive.
Dr. Carlos Fava.
Member of the editorial board of SOLACI.org.
Reference: Ko Yamamoto, et al. J Am Coll Cardiol Intv 2023;16:19–31.
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