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New ACC/AHA stent guideline
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Thanks
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Hallelujah,
Don't have to wait full 12 months anymore with new generation DES. 6 Months may be enough now.
"A shorter duration of DAPT results in fewer bleeding complications (30,34-36). Shorter-duration DAPT may be most reasonable in patients currently being treated with “newergeneration” (e.g., everolimus- or zotarolimus-eluting) DES, which are associated with lower stent thrombosis and MI rates than those of “first-generation” (e.g., sirolimus- and paclitaxel-eluting) DES, which are rarely, if ever, used in current clinical practice"
Don't have to wait full 12 months anymore with new generation DES. 6 Months may be enough now.
"A shorter duration of DAPT results in fewer bleeding complications (30,34-36). Shorter-duration DAPT may be most reasonable in patients currently being treated with “newergeneration” (e.g., everolimus- or zotarolimus-eluting) DES, which are associated with lower stent thrombosis and MI rates than those of “first-generation” (e.g., sirolimus- and paclitaxel-eluting) DES, which are rarely, if ever, used in current clinical practice"
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So here is the meat of the recommendation for those not wanting to comb through it:
"The recommended minimum duration of DAPT in patients treated with first-generation DES, based primarily on observational data and one subgroup analysis, has been 12 months (9,51,97,104,105). Compared with first-generation DES, currently used newer-generation DES have a lower risk of stent thrombosis and appear to require a shorter minimum duration of DAPT (17,18,21,38,96,97). Five RCTs (17-21) of primarily low-risk (non-ACS) patients treated with DES comparing shorter-duration (3 to 6 months) DAPT with 12 months of DAPT, as well as several meta-analyses (34-37) and an analysis by the ERC (30), did not find an increased risk of stent thrombosis with shorter-duration DAPT, although the individual trials were underpowered to detect such a difference (Data Supplements 1 and 3). Therefore, in patients with SIHD treated with DES, the minimum recommended duration of DAPT has been decreased from 12 to 6 months. The PCI-CURE analysis (51) of patients in the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial (52) demonstrated that treatment with DAPT for up to 12 months in patients with NSTEACS treated with BMS reduced ischemic events compared with aspirin monotherapy (Data Supplement 4). Based Primarily on the CURE trial and PCI-CURE analyses, the prior recommendation that patients with NSTE-ACS treated with coronary stent implantation be treated with DAPT for at least 12 months is continued in this update and has been extrapolated to patients with STEMI treated with PCI as well, on the basis of the consideration that NSTE-ACS and STEMI are part of the spectrum of ACS."
Essentially, if the patient was stented with a DES due to sustaining a STEMI or NSTEMI, they should still be on dual anti-platelet for 12 months.
If they were stented for other reasons (angina, CAD, etc) with a newer generation DES (which I guess is what most cardiologists use now), then they only have to be on dual anti-platelets for 6 months.
"The recommended minimum duration of DAPT in patients treated with first-generation DES, based primarily on observational data and one subgroup analysis, has been 12 months (9,51,97,104,105). Compared with first-generation DES, currently used newer-generation DES have a lower risk of stent thrombosis and appear to require a shorter minimum duration of DAPT (17,18,21,38,96,97). Five RCTs (17-21) of primarily low-risk (non-ACS) patients treated with DES comparing shorter-duration (3 to 6 months) DAPT with 12 months of DAPT, as well as several meta-analyses (34-37) and an analysis by the ERC (30), did not find an increased risk of stent thrombosis with shorter-duration DAPT, although the individual trials were underpowered to detect such a difference (Data Supplements 1 and 3). Therefore, in patients with SIHD treated with DES, the minimum recommended duration of DAPT has been decreased from 12 to 6 months. The PCI-CURE analysis (51) of patients in the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial (52) demonstrated that treatment with DAPT for up to 12 months in patients with NSTEACS treated with BMS reduced ischemic events compared with aspirin monotherapy (Data Supplement 4). Based Primarily on the CURE trial and PCI-CURE analyses, the prior recommendation that patients with NSTE-ACS treated with coronary stent implantation be treated with DAPT for at least 12 months is continued in this update and has been extrapolated to patients with STEMI treated with PCI as well, on the basis of the consideration that NSTE-ACS and STEMI are part of the spectrum of ACS."
Essentially, if the patient was stented with a DES due to sustaining a STEMI or NSTEMI, they should still be on dual anti-platelet for 12 months.
If they were stented for other reasons (angina, CAD, etc) with a newer generation DES (which I guess is what most cardiologists use now), then they only have to be on dual anti-platelets for 6 months.
