PracticeUpdate Cardiology Best of 2018

CONFERENCE COVERAGE 18

American College of Cardiology 67 TH Annual Scientific Session & Expo 2018

10–12 MARCH 2018 • ORLANDO, FLORIDA, USA

Optimal Duration of DAPT Therapy Post PCI in Acute Coronary Syndrome Interview with Deepak L. Bhatt MD, MPH, FACC, FAHA, FSCAI, FESC

months of dual antiplatelet therapy is indi- cated in patients with ACS unless there’s some reason it should be stopped sooner, such as bleeding, in which case you’ve got to do what common sense dictates. But for the patient at low bleeding risk, who is not bleeding while on DAPT, continuing for 12 months or more appears to be the right thing to do, based not only on this trial but the cumulative evidence. PracticeUpdate: What are your thoughts on optimal duration of DAPT post PCI for the current generation of drug-eluting stents in ACS patients? Dr. Bhatt: The current generation of drug-eluting stents is clearly associated with a lower rate of stent thrombosis than first generation drug-eluting stents and probably even a lower rate than seen with bare-metal stents. This has to do with the combination of drug polymer, stent engi- neering, stent strut thickness, thinner being better with respect to restenosis and thrombosis risk. So all these advances in stent technology have led to stents that are more efficacious, very low restenosis rates,

Professor of Medicine at Harvard Medical School, Executive Director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital Heart and Vascular Center, and Senior Physician at Brigham and Women’s Hospital in Boston, Massachusetts.

PracticeUpdate: The SMART-DATE trial was presented this year and studied duration of DAPT post PCI for ACS. Could you give us an overview of this trial? Dr. Bhatt: The SMART DAPT trial was a very clever design taking ACS patients under- going stenting and randomizing them to 6 months of dual antiplatelet therapy ver- sus 12 or more months of dual antiplatelet therapy. The trial overall showed that both strategies performed similarly in a statisti- cal sense; however, there was a significant

excess of myocardial infarction in the patients randomized to the shorter dura- tion of DAPT. In particular, in patients who were ana- lyzed after the 6-month point, those that were randomized to at that point having no DAPT versus a longer duration, had almost a five-fold excess of myocardial infarction. Therefore, this study nicely corroborates what the guidelines say to do already and what older trials have already shown us, such as the CURE trial, that at least 12

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