Breaking News
September 20, 2018 - Senators unveil legislation to protect patients against surprise medical bills
September 20, 2018 - Study provides insights into development of special-purpose cosmetic products
September 20, 2018 - Research shows enlarged genotype-phenotype correlation for three-base pair deletion in NF1
September 20, 2018 - Mediterranean-style diet appears to reduce stroke risk in women
September 20, 2018 - AbbVie Announces Patient-Reported Outcomes Data from Three Pivotal Phase 3 Studies of Risankizumab, Showing Significant Improvements in Health-Related Quality of Life for Patients with Psoriasis
September 20, 2018 - Characterization of pregnancy microbiome reveals variations in bacterial diversity
September 20, 2018 - New guidance for treatment of bone loss in hematologic stem cell transplant Recipients
September 20, 2018 - Experts to present research on prevention, management of dysphagia at international conference
September 20, 2018 - New study focuses on two-way gene switches controlling gene activity
September 20, 2018 - Zika virus could become a weapon against brain cancer
September 20, 2018 - Home-based video game exercises can reduce chronic low back pain in older people, study finds
September 20, 2018 - Investigators find that bile acids reduce cocaine reward
September 20, 2018 - Cannabinoid drugs reduce perceived unpleasantness of painful stimuli and increase tolerance
September 20, 2018 - Health care companies’ data could enable more accurate flu season forecasts
September 20, 2018 - Geroscience takes center stage in Journal of the American Medical Association
September 20, 2018 - Ambient Particulate Matter Linked to Emergency Asthma Care
September 20, 2018 - Patient satisfaction with plastic surgery—it’s the surgeon, not the practice
September 20, 2018 - Medicine is a team sport – and that’s exactly how it should be
September 20, 2018 - Logos Biosystems releases new electrophoretic tissue clearing system with twice the features in half the space
September 20, 2018 - Novel micro-platform reveals never-before-seen behaviors of cancer cells
September 20, 2018 - PAREXEL partners with Datavant to enhance clinical study design and generate real-world evidence
September 20, 2018 - Robert Koch Institute publishes new data on allergies, mental health problems, and accident injuries
September 20, 2018 - Study finds higher readmission rates in for-profit hospitals
September 20, 2018 - Encouraging youth to do strength-based exercises could help tackle child obesity
September 20, 2018 - Sleep apnea, congenital heart disease in hospitalized infants strongly associated with death
September 20, 2018 - Researchers find way to map mysterious content of non-coding RNA
September 20, 2018 - Air Pollutants Reach Placenta, Might Harm Fetus: Study
September 20, 2018 - Sleep apnea, congenital heart disease may be deadly mix for hospitalized infants
September 20, 2018 - My relative has cancer, should I worry? Encouraging cascade genetic testing
September 20, 2018 - Investigators determine specific treatable traits that can predict future asthma attacks
September 20, 2018 - More doctor visits can lower risk of suicide attempts in fibromyalgia patients
September 20, 2018 - Computer avatars play role in diagnosis of dementia
September 20, 2018 - Addition of CTLA4 targeted therapy to PD-1 targeted therapy may benefit patients with ovarian cancer
September 20, 2018 - ASPREE trial explores whether low dose aspirin can prolong good health in elderly people
September 20, 2018 - ATS publishes new guideline focused on weight loss strategies for sleep apnea patients
September 20, 2018 - The Current issue of “The view from here” is concerned with Drug Delivery
September 19, 2018 - Sleep apnea could favour tumor growth at young ages
September 19, 2018 - Stealth vaping fad hidden from parents, teachers
September 19, 2018 - Witnessing school violence linked to later risk of psycho-social and academic impairment
September 19, 2018 - Common household cleaners could make children overweight by changing gut microbiota
September 19, 2018 - Salk research in yeast leads to serendipitous finding about hypomyelinating leukodystrophy
September 19, 2018 - Study: Overweight or obese women may have increased risk of urinary incontinence
September 19, 2018 - Study shows how cellular waste disposal processes also promote inflammation
September 19, 2018 - New multidisciplinary microsurgery microscope, PROVIDO, introduced by Leica
September 19, 2018 - Phase 2b STORM Data Evaluating Selinexor in Patients with Penta-Refractory Multiple Myeloma Presented at the Society of Hematologic Oncology 2018 Annual Meeting
September 19, 2018 - Decisions recruiting gut feelings seen as reflection of true self, more assuredly held, study says
September 19, 2018 - How AI can improve end-of-life care
September 19, 2018 - UNIST and Ulsan initiate research collaboration to develop human organs-on-chips
September 19, 2018 - Study highlights key role of migrating shoals of fish in sustaining deep-ocean microorganisms
September 19, 2018 - Disagreeable individuals can benefit most from behaving more compassionately, finds study
September 19, 2018 - Janssen Submits New Drug Application to U.S. FDA Seeking Approval of Erdafitinib for the Treatment of Metastatic Urothelial Cancer
September 19, 2018 - Neuroplasticity is increased but dysregulated in the aging brain, study finds
September 19, 2018 - Suicide: A public health crisis
September 19, 2018 - Infants using popular anti-reflux medicines are not at increased risk of lung infections
September 19, 2018 - Stanford team will participate in NIH-funded study of tobacco policies | News Center
September 19, 2018 - Women with high levels of anti-Müllerian hormone more likely to develop breast cancer
September 19, 2018 - Researchers use larval zebrafish model to reveal role of locus coeruleus in anesthesia
September 19, 2018 - Effects of prematurity found to be more severe for the brains of males than females
September 19, 2018 - NIH funds CWRU to investigate new imaging approach for diagnosing peripheral arterial disease
September 19, 2018 - NUS researchers develop new device for quick and accurate screening of diseases
September 19, 2018 - Leading nutritionist explains about different types of iron in oral supplements
September 19, 2018 - New Crest Gum & Enamel Repair toothpaste may boost enamel repair and reverse gingivitis
September 19, 2018 - Analysis does not find any safety concerns of bivalent HPV vaccine
September 19, 2018 - Many Older Adults Transition to Long-Term Benzodiazepine Use
September 19, 2018 - Caregiving – resources – older adults: MedlinePlus Medical Encyclopedia
September 19, 2018 - Research shows that cystic fibrosis impacts growth in the womb
September 19, 2018 - Study shows how head, neck positioning affects concussion risk | News Center
September 19, 2018 - Antioxidant in green tea helps sneak therapeutic RNAs into cells
September 19, 2018 - Excess pregnancy weight gain affects cardiometabolic risk in offspring
September 19, 2018 - Penn researchers find common thread linking almost all TNR expansion diseases
September 19, 2018 - Ipsen receives approval from Health Canada for CABOMETYX tablets for treating renal cell carcinoma
September 19, 2018 - Researchers use CRISPR screen to reveal new targets in squamous cell carcinomas
September 19, 2018 - UGR to coordinate the European H2020 project focused on Smart Personalized Nutrition
September 19, 2018 - Mumps Spread Quickly at Texas Cheerleading Meets: Study
September 19, 2018 - Addressing child stunting in Pakistan is critical
September 19, 2018 - Innovative system makes hospitals, clinics accessible for people with visual impairments
September 19, 2018 - CXCL14 protein is secreted by brown adipose tissue and has beneficial effects in metabolic diseases
September 19, 2018 - Air pollution increases risk of dementia
September 19, 2018 - Inequality issues persist even under new U.S. kidney transplant allocation system
September 19, 2018 - New study reveals mechanisms that lead to cognitive decline in Type 2 diabetes
Mixed Results for Shorter DAPT in ACS Patients

Mixed Results for Shorter DAPT in ACS Patients

image_pdfDownload PDFimage_print

ORLANDO — Although a shorter duration of dual antiplatelet therapy (DAPT) was non-inferior to the standard regimen among acute coronary syndrome (ACS) patients getting drug-eluting stents (DES) in the SMART-DATE trial, a signal of excess MIs led investigators to caution against the interpretation that the two are equally safe.

Overall protection against recurrent ischemic events in the 18 months after percutaneous coronary intervention (PCI) — namely combined all-cause mortality, MI, and cerebrovascular events — was about the same whether ACS patients got 6 months or 12 months of DAPT (4.7% vs 4.2%, HR 1.13, 95% CI 0.79-1.62, P=0.027 for non-inferiority).

No difference was observed in the individual endpoints of all-cause death, stent thrombosis, and bleeding, an intention-to-treat analysis showed. However, MI turned out to be more likely with 6-month DAPT (1.8% vs 0.8%, P=0.02), Hyeon Cheol Gwon, MD, of Samsung Medical Center in South Korea, said at a late-breaking trial session at the American College of Cardiology (ACC) annual meeting. The findings were simultaneously published in the Lancet.

The MI difference was no longer significant on per-protocol analysis (1.6% vs 0.8%, P=0.10), they reported. Still, “although the non-inferiority of the 6-month DAPT to 12-month or longer DAPT was met, the increased MI risk with 6-month DAPT prevent us from concluding that short-term DAPT is safe in ACS patients undergoing PCI with current-generation DES,” the investigators emphasized.

“Prolonged DAPT in ACS patients without excessive risk of bleeding should remain the standard of care,” they said, noting that 12 months of DAPT is currently recommended for this population.

Click here for video comments from study authors and discussants at ACC 2018.

Close to 60% of MIs were found in the target vessel during index PCI.

“It’s interesting that you met the primary endpoint, but you are advising against change in practice,” said ACC session panelist Roxana Mehran, MD, of Mount Sinai School of Medicine in New York City.

Gregg Stone, MD, of Columbia University Medical Center/New York-Presbyterian Hospital, added that the findings are similar to those of the REDUCE trial in which shorter DAPT was tied to “strong trends” in death and stent thrombosis among patients receiving the Combo sirolimus-eluting bioresorbable polymer stent.

SMART-DATE had 2,712 ACS patients randomized to one of the two DAPT regimens across 31 centers in South Korea. This cohort had also been randomized to PCI with the zotarolimus-eluting Resolute Integrity, everolimus-eluting Xience Prime, or biolimus A9-eluting BioMatrix Flex stents.

Excluded populations were those with recent major bleeding and prior DES implantation within a year, for example.

The 6-month DAPT group adhered to their assignment treatment in 73.7% of cases, while the 12-month group did so in 95.7%. Having so many crossovers in the former was a major limitation of the open-label trial, Gwon acknowledged.

“These are difficult trials to perform,” Stone noted, adding that here there is a methodological issue that is common in these types of studies. By randomizing patients before the actual switch in DAPT duration, “anything that happens in 6 months just adds noise,” he said. “The optimal way is to randomize at 6 months.”

Nonetheless, the present findings appear to refute the sentiment that older stents were guiding guidelines on DAPT duration and that things would be different with newer DES, according to Dipti Itchhaporia, MD, of Hoag Memorial Hospital Presbyterian in Newport Beach, California.

“It’s nicely shown with the risk of MI in 6-month DAPT that [newer DES are] not enough to make us feel comfortable. The ACS patient is fundamentally a different kind of patient,” she said at an ACC press conference.

SMART-DATE was funded by Abbott Vascular Korea, Medtronic Vascular Korea, Biosensors, and Dong-A ST.

Gwon disclosed relevant relationships with Medtronic, Abbott, and Boston Scientific.

2018-03-13T09:15:05-0400

Tagged with:

About author

Related Articles