Authors
Hahn JY, Song YB, Choi JH, et al.
Title
Three-Month Dual Antiplatelet Therapy After Implantation of Zotarolimus-Eluting Stents – The DATE (Duration of Dual Antiplatelet Therapy After Implantation of Endeavor Stent) Registry
References
Circ J 2010;74:2314-21.
Background
The optimal duration of dual antiplatelet therapy remains controversial.
Purpose
To determine the feasibility of 3-month dual antiplatelet therapy after Zotarolimus eluting stent (ZES) implantation in relatively low-risk patients with coronary artery disease.
Design
Prospective multicenter cohort study based on registry data
  • inclusion criteria: (1) clinically significant coronary stenosis (2) de novo coronary lesions; and (3) exclusive treatment with ZES
  • Endpoints; composite of cardiac death, MI, or definite/probable stent thrombosis at 1 year
Exclusion Criteria
  1. Cardiogenic shock, STEMI within 48 hour of onset, previous implantation of DES, and severe left ventricular dysfunction (left ventricular ejection fraction <25%) or congestive heart failure;
  2. Lesion characteristics including total stent length >60mm, bifurcation lesions requiring side branch stenting, left main lesions, and graft lesions; and
  3. Clopidogrel use for reasons other than PCI, use of warfarin or antiplatelet therapy other than aspirin and clopidogrel, hyper-sensitivity to aspirin or clopidogrel, expected survival less than 1 year, child-bearing age in women, bleeding diathesis, major bleeding within 3 months, and renal dysfunction (serum creatinine >2.0mg/dL).
Follow-Up
1 year
Treatment Regimen
  • Loading doses of aspirin (300 mg) and clopidogrel (300–600 mg)
  • Glycoprotein IIb/IIIa receptor antagonists were all at the operator’s discretion
  • Aspirin (100–200mg once daily) indefinitely.
  • Discontinuation of clopidogrel (75mg once daily) at 3 months
Results
Primary Endpoints:
  • Discontinuation of clopidogrel at 3 months did not increase the primary outcome (HR 0.90; 95%CI, 0.09–9.02), death, MI, or any revascularization (HR 0.89; 95%CI, 0.48–1.67) after adjustment for the propensity score.
Summary
Three-month dual antiplatelet therapy seems to be feasible after ZES implantation in relatively low-risk patients.
Implications
This manuscript supported evolving evidence that among low risk patients, a short duration of DAPT therapy may be sufficient. The data needs to be confirmed by large randomized controlled trials in the future.
Related Figures
None.