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Stent thrombosis and optimal duration of dual antiplatelet therapy after coronary stenting in contemporary practice

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대한내과학회 (The Korean Association Of Internal Medicine)|2017.09|The Korean Journal of Internal Medicine|제32권 제5호|pp. 769-779|DOI https://doi.org/10.3904/kjim.2016.391

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키워드

ThrombosisPercutaneous coronary interventionPlatelet aggregation inhibitorsDrug-eluting stents
주제분류내과학

초록

The introduction of drug-eluting stents (DES) in the practice of percutaneous coronary intervention (PCI) has substantially reduced angiographic and clinical restenosis but is associated with an increasing propensity for very late stent thrombosis (ST). Among several clinical, lesion, or procedure-related predictors of ST, early discontinuation of dual antiplatelet therapy (DAPT) is the most important factor for DES-associated late thrombosis; therefore, the optimal duration of DAPT is a major issue to be critically considered in the current DES era. Given that the benefit and risk of longer duration DAPT should be simultaneously considered, the optimal DAPT period following DES implantation has been controversial. Several small-to-medium sized randomized clinical trials and observational registries have indicated that short-term DAPT (< 6 months) is not inferior to 12-month DAPT with fewer bleeding events, whereas prolonged duration of DAPT (> 12 months) failed to prove its superiority. However, compelling evidence from a landmark DAPT trial has clearly demonstrated the efficacy of prolonged DAPT up to 30 months in terms of preventing ST and major cardiovascular adverse events at the expense of major bleeding. In addition, coupled with various risk algorithms, a more individualized approach to balance the efficacy and safety of optimal DAPT duration has been emphasized. In this review article, we systematically summarize the cumulative evidence from key clinical studies and try to help the physician make decisions on the optimal duration of DAPT in contemporary PCI practice.

Abstract

The introduction of drug-eluting stents (DES) in the practice of percutaneous coronary intervention (PCI) has substantially reduced angiographic and clinical restenosis but is associated with an increasing propensity for very late stent thrombosis (ST). Among several clinical, lesion, or procedure-related predictors of ST, early discontinuation of dual antiplatelet therapy (DAPT) is the most important factor for DES-associated late thrombosis; therefore, the optimal duration of DAPT is a major issue to be critically considered in the current DES era. Given that the benefit and risk of longer duration DAPT should be simultaneously considered, the optimal DAPT period following DES implantation has been controversial. Several small-to-medium sized randomized clinical trials and observational registries have indicated that short-term DAPT (< 6 months) is not inferior to 12-month DAPT with fewer bleeding events, whereas prolonged duration of DAPT (> 12 months) failed to prove its superiority. However, compelling evidence from a landmark DAPT trial has clearly demonstrated the efficacy of prolonged DAPT up to 30 months in terms of preventing ST and major cardiovascular adverse events at the expense of major bleeding. In addition, coupled with various risk algorithms, a more individualized approach to balance the efficacy and safety of optimal DAPT duration has been emphasized. In this review article, we systematically summarize the cumulative evidence from key clinical studies and try to help the physician make decisions on the optimal duration of DAPT in contemporary PCI practice.

참고문헌 (65)

  1. Stefanini GG, "Drug-eluting coronary-artery stents", N Engl J Med, 368, pp.254~265 (2013)
  2. Stettler C, "Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis", Lancet, 370, pp.937~948 (2007)
  3. Armstrong EJ, "Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis", JACC Cardiovasc Interv, 5, pp.131~140 (2012)
  4. Schulz S, "Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period", Eur Heart J, 30, pp.2714~2721 (2009)
  5. Holmes DR Jr, "Stent thrombosis", J Am Coll Cardiol, 56, pp.1357~1365 (2010)
  6. Nakazawa G, "Delayed arterial healing and increased late stent thrombosis at culpritsites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study", Circulation, 118, pp.1138~1145 (2008)
  7. Kotani J, "Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings", J Am Coll Cardiol, 47, pp.2108~2111 (2006)
  8. Finn AV, "Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization", Circulation, 115, pp.2435~2441 (2007)
  9. Kolh P, "2014 ESC", EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), 2014, pp.46, 517~592
  10. Levine GN, "2011 ACCF", AHA, American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions, pp.Circulation, 2011[DOI]
  11. Berger PB, "Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease:results from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial", Circulation, 121, pp.2575~2583 (2010)
  12. Bowry AD, "Meta-analysis of the efficacy and safety of clopidogrel plus aspirin as compared to antiplatelet monotherapy for the prevention of vascular events", Am J Cardiol, 101, pp.960~966 (2008)
  13. Doyle BJ, "Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice", J Am Coll Cardiol, 53, pp.2019~2027 (2009)
  14. Iwata Y, "Incidence of premature discontinuation of antiplatelet therapy after sirolimus-eluting stent implantation", Circ J, 72, pp.340~341 (2008)
  15. 조연경, "Efficacy and safety of antiplatelet-combination therapy after drug-eluting stent implantation", The Korean Journal of Internal Medicine, 29(2), pp.210~216 (2014), 대한내과학회[DOI]
  16. Riegger J, "Histopathological evaluation of thrombus in patients presenting with stent thrombosis. A multicenter European study: a report of the prevention of late stent thrombosis by an interdisciplinary global European effort consortium", Eur Heart J, 37, pp.1538~1549 (2016)
  17. Cutlip DE, "Clinical end points in coronary stent trials: a case for standardized definitions", Circulation, 115, pp.2344~2351 (2007)
  18. van Werkum JW, "Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry", J Am Coll Cardiol, 53, pp.1399~1409 (2009)
  19. Tada T, "Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients", JACC Cardiovasc Interv, 6, pp.1267~1274 (2013)
  20. Raber L, "Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents:a prospective cohort study", Circulation, 125, pp.1110~1121 (2012)
  21. Stone GW, "Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study", Lancet, 382, pp.614~623 (2013)
  22. Palmerini T, "Stent thrombosis with everolimus-eluting stents: meta-analysis of comparative randomized controlled trials", Circ Cardiovasc Interv, 5, pp.357~364 (2012)
  23. Daemen J, "Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice:data from a large two-institutional cohort study", Lancet, 369, pp.667~678 (2007)
  24. Airoldi F, "Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment", Circulation, 116, pp.745~754 (2007)
  25. Lagerqvist B, "Stent thrombosis in Sweden: a report from the Swedish Coronary Angiography and Angioplasty Registry", Circ Cardiovasc Interv, 2, pp.401~408 (2009)
  26. Finn AV, "Vascular responses to drug eluting stents: importance of delayed healing", Arterioscler Thromb Vasc Biol, 27, pp.1500~1510 (2007)
  27. Byrne RA, "Polymer coatings and delayed arterial healing following drug-eluting stent implantation", Minerva Cardioangiol, 57, pp.567~584 (2009)
  28. Luscher TF, "Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications", Circulation, 115, pp.1051~1058 (2007)
  29. Kolandaivelu K, "Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings", Circulation, 123, pp.1400~1409 (2011)
  30. Weisz G, "Five-year follow-up after sirolimus-eluting stent implantation results of the SIRIUS (Sirolimus-Eluting Stent in De-Novo Native Coronary Lesions) Trial", J Am Coll Cardiol, 53, pp.1488~1497 (2009)
  31. Stone GW, "Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents", N Engl J Med, 356, pp.998~1008 (2007)
  32. Palmerini T, "Stent thrombosis with drug-eluting and bare-metal stents:evidence from a comprehensive network meta-analysis", Lancet, 379, pp.1393~1402 (2012)
  33. Bangalore S, "Short- and longterm outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117,762 patient-years of follow-up from randomized trials", Circulation, 125, pp.2873~2891 (2012)
  34. Palmerini T, "Longterm safety of drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis", J Am Coll Cardiol, 65, pp.2496~2507 (2015)
  35. Leon MB, "A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting: Stent Anticoagulation Restenosis Study Investigators", N Engl J Med, 339, pp.1665~1671 (1998)
  36. Schomig A, "A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents", N Engl J Med, 334, pp.1084~1089 (1996)
  37. Ueda Y, "Neointimal coverage of stents in human coronary arteries observed by angioscopy", J Am Coll Cardiol, 23, pp.341~346 (1994)
  38. Bergeron P, "Long-term peripheral stent evaluation using angioscopy", Int Angiol, 10, pp.182~186 (1991)
  39. Kim BK, "A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation)", J Am Coll Cardiol, 60, pp.1340~1348 (2012)
  40. Feres F, "Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial", JAMA, 310, pp.2510~2522 (2013)
  41. Gwon HC, "Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience", Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT)randomized, multicenter study, 2012, pp.125, 505~513
  42. Colombo A, "Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial", J Am Coll Cardiol, 64, pp.2086~2097 (2014)
  43. Schulz-Schupke S, "ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting", Eur Heart J, 36, pp.1252~1263 (2015)
  44. Gilard M, "6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin:the randomized, multicenter ITALIC trial", J Am Coll Cardiol, 65, pp.777~786 (2015)
  45. Valgimigli M, "Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial", Circulation, 125, pp.2015~2026 (2012)
  46. Collet JP, "Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): a randomised trial", Lancet, 384, pp.1577~1585 (2014)
  47. Lee CW, "Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation:a randomized, controlled trial", Circulation, 129, pp.304~312 (2014)
  48. Helft G, "Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial", Eur Heart J, 37, pp.365~374 (2016)
  49. Mauri L, "Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents", N Engl J Med, 371, pp.2155~2166 (2014)
  50. Palmerini T, "Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation:a pairwise and Bayesian network meta-analysis of randomised trials", Lancet, 385, pp.2371~2382 (2015)
  51. Giustino G, "Duration of dual antiplatelet therapy after drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials", J Am Coll Cardiol, 65, pp.1298~1310 (2015)
  52. Levine GN, "2016 ACC", AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology, J Am Coll Cardiol, pp.2016, 68[DOI]
  53. Yeh RW, "Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention", JAMA, 315, pp.1735~1749 (2016)
  54. Iqbal J, "Bioresorbable scaffolds: rationale, current status, challenges, and future", Eur Heart J, 35, pp.765~776 (2014)
  55. Ellis SG, "Everolimus-eluting bioresorbable scaffolds for coronary artery disease", N Engl J Med, 373, pp.1905~1915 (2015)
  56. Serruys PW, "A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from a randomized controlled trial", Lancet, 385, pp.43~54 (2015)
  57. Kimura T, "A randomized trial evaluating everolimus-eluting Absorb bioresorbable scaffolds vs. everolimus-eluting metallic stents in patients with coronary artery disease: ABSORB Japan", Eur Heart J, 36, pp.3332~3342 (2015)
  58. Gao R, "Bioresorbable vascular scaffolds versus metallic stents in patients with coronary artery disease: ABSORB China Trial", J Am Coll Cardiol, 66, pp.2298~2309 (2015)
  59. Stone GW, "1-Year outcomes with the absorb bioresorbable scaffold in patients with coronary artery disease: a patient-level, pooled meta-analysis", Lancet, 387, pp.1277~1289 (2016)
  60. Cassese S, "Everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents: a meta-analysis of randomised controlled trials", Lancet, 387, pp.537~544 (2016)
  61. Puricel S, "Bioresorbable coronary scaffold thrombosis: multicenter comprehensive analysis of clinical presentation, mechanisms, and predictors", J Am Coll Cardiol, 67, pp.921~931 (2016)
  62. Cuculi F, "Optical coherence tomography findings in bioresorbable vascular scaffolds thrombosis", Circ Cardiovasc Interv, 8, pp.e002518~ (2015)
  63. Raber L, "Very late scaffold thrombosis: intracoronary imaging and histopathological and spectroscopic findings", J Am Coll Cardiol, 66, pp.1901~1914 (2015)
  64. Stefanini GG, "Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials", Eur Heart J, 33, pp.1214~1222 (2012)
  65. CAPRIE Steering Committee., "A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)", Lancet, 348, pp.1329~1339 (1996)

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