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Effect of Prolonged Thienopyridine Use After Drug-Eluting Stent Implantation (from the TAXUS Landmark Trials Data)

2008; Elsevier BV; Volume: 102; Issue: 8 Linguagem: Inglês

10.1016/j.amjcard.2008.05.050

1879-1913

Gregg W. Stone, Stephen G. Ellis, Antonio Colombo, Eberhard Grube, Keith D. Dawkins, Mark I. Friedman, Donald S. Baim,

Cardiac Imaging and Diagnostics

Previous observational studies have evaluated the utility of prolonged thienopyridine therapy in patients receiving drug-eluting stents, with conflicting results. A landmark analysis was therefore performed on the basis of the prospective, double-blind TAXUS-II SR, TAXUS-IV, and TAXUS-V trials. Of 2,736 randomized patients, 2,171 were event free at 1 year, of whom 964 (44.4%) at physician discretion were still taking thienopyridines at that time. Among the 1,141 event-free patients randomized to Taxus stents, a trend was present in those patients still taking compared with those having discontinued thienopyridines at 1 year to have numerically fewer very late stent thrombosis episodes at 2 years (0 vs 4 [0.7%] events, respectively, p = 0.07) and 5 years (4 [0.8%] vs 8 [1.4%] events, respectively, p = 0.43). However, in event-free Taxus patients taking compared with those not taking thienopyridines at 1 year, there were no significant differences in the 2- and 5-year rates of death (1.4% vs 0.6%, p = 0.22, and 6.0% vs 7.4%, p = 0.83, respectively) and death or myocardial infarction (1.8% vs 1.9%, p = 0.82, and 8.3% vs 9.8%, p = 0.75, respectively). There were no significant interactions between 1-year thienopyridine use status and stent type (Taxus vs bare-metal stent) on the individual or composite end points of stent thrombosis, death, or myocardial infarction at either 2 or 5 years (all interaction p values >0.50). In conclusion, thienopyridine use beyond 1 year after drug-eluting stent implantation may reduce stent thrombosis over the subsequent 12-month period, but the rates of death and myocardial infarction at 2 and 5 years are not prevented by extended thienopyridine use after either drug-eluting or bare-metal stent implantation. Previous observational studies have evaluated the utility of prolonged thienopyridine therapy in patients receiving drug-eluting stents, with conflicting results. A landmark analysis was therefore performed on the basis of the prospective, double-blind TAXUS-II SR, TAXUS-IV, and TAXUS-V trials. Of 2,736 randomized patients, 2,171 were event free at 1 year, of whom 964 (44.4%) at physician discretion were still taking thienopyridines at that time. Among the 1,141 event-free patients randomized to Taxus stents, a trend was present in those patients still taking compared with those having discontinued thienopyridines at 1 year to have numerically fewer very late stent thrombosis episodes at 2 years (0 vs 4 [0.7%] events, respectively, p = 0.07) and 5 years (4 [0.8%] vs 8 [1.4%] events, respectively, p = 0.43). However, in event-free Taxus patients taking compared with those not taking thienopyridines at 1 year, there were no significant differences in the 2- and 5-year rates of death (1.4% vs 0.6%, p = 0.22, and 6.0% vs 7.4%, p = 0.83, respectively) and death or myocardial infarction (1.8% vs 1.9%, p = 0.82, and 8.3% vs 9.8%, p = 0.75, respectively). There were no significant interactions between 1-year thienopyridine use status and stent type (Taxus vs bare-metal stent) on the individual or composite end points of stent thrombosis, death, or myocardial infarction at either 2 or 5 years (all interaction p values >0.50). In conclusion, thienopyridine use beyond 1 year after drug-eluting stent implantation may reduce stent thrombosis over the subsequent 12-month period, but the rates of death and myocardial infarction at 2 and 5 years are not prevented by extended thienopyridine use after either drug-eluting or bare-metal stent implantation.