Table 1

Studies Examining the Relationship Between DAPT Duration and Late/Very Late ST After DES Revascularization

Authors (Ref. #)Study
Population, n
Study DurationDeathMISTComments
Airoldi et al. (19)3,021 DES18 monthsST cases: 39%ST cases: 79%Overall rate 1.9%; HR for TP cessation: <6 months, 13.7 (CI: 4.0–46.7), >6 months, 0.94 (0.3–2.98)Protective effect of TP on ST observed only within first 6 months of DES treatment; median time to ST from TP discontinuation: 14 days within first 6 months, 90 days thereafter
Park et al. (21)2,873 DES patients 12-month event-free3 yrsHR: 1.20 (CI: 0.55–2.66) for continuing TP beyond 1 yr vs. discontinuationHR: 0.53 (CI: 0.07–4.11) for continuing TP beyond 1 yr vs. discontinuationHR: 0.54 (CI: 0.07–4.23) for continuing TP beyond 1 yr vs. discontinuationNo reduction in major adverse events with TP continuation beyond 1 yr in 12-month event-free patients; outcomes adjusting according to propensity score model
Schulz et al. (23)6,816 DES4 yrs4.2% (overall)8.6% (overall)HR/day for ST at ≤6 months vs. >6 months: 0.98 (CI: 0.98–0.99) vs. 1.00 (CI: 0.99–1.01)Protective effect of TP on ST observed only within first 6 months of DES treatment; median time interval from TP discontinuation to ST was 9 days within first 6 months vs. 104 days thereafter
Roy et al. (20)2,889 DES1 yrN/AN/AOdds ratios for TP cessation: 30 days, 4.5 (CI: 2.0–10.4); 6 months, 2.4 (CI: 1.2–4.9); 1 yr, 1.7 (0.9–3.1)Protective effect of TP on ST not observed past 6 months; TP compliance 73.8% in patients presenting with ST (82.6% for early ST, 43.8% for late ST)
Kimura et al. (22)10,778 SES2 yrsOn TP, 3.4%; off TP, 3.4%On TP, 0.6%; off TP, 0.8%No significant difference in definite ST at any time interval through 730 days between on and off TPAdjusted event rates; discontinuation of both aspirin and TP associated with definite ST at any time point
van Werkum et al. (24)21,009 DES and BMS30.9 monthsN/AN/AHR for TP cessation: <30 days, 36.5 (CI: 8.0–167.8); 180–365 days, 5.9 (CI: 1.7–19.8)ST also associated with stent undersizing, TIMI flow grade <3, present malignancy, nontarget lesion target vessel disease, dissection, lack of aspirin, bifurcation, and young age

BMS = bare-metal stent(s); CI = confidence interval; DAPT = dual antiplatelet therapy; DES = drug-eluting stent(s); HR = hazard ratio; MI = myocardial infarction; N/A = not available; SES = sirolimus-eluting stent(s); ST = stent thrombosis; TIMI = Thrombolysis In Myocardial Infarction; TP = thienopyridine.