040 Is it long-term (> 12 months) dual antiplatelet treatment necessary in diabetic patients treated with drug-eluting stents?

BackgroundDespite encouraging short-term results with drug-eluting stents (DES) in diabetes mellitus (DM) patients (pts) with coronary artery disease, the long-term safety is not clear. We investigated the influence of long-term (> 12 months) dual antiplatelet treatment (APLT) with aspirin and clopidogrel on clinical outcome in DM pts treated with DES.MethodsThe study included 552 consecutive DM pts (male 81%, mean age 65+9 years) that had been treated with DES and received dual APLT treatment for 12 months. Long-term clinical follow-up (FU) (mean time 30.4 + 11.6 months), obtained in 545/552 (99%) of them; 419 (77%) pts were on dual APLT (group A) and 126 (23%) on single APLT (group B). Major adverse cardiovascular event (MACE) on clinical FU was considered death (D), myocardial infarction (MI), percutaneous or surgical revascularization (REV), cerebrovascular accident (CVA), and hard end-points (HDP) was considered D, MI and CVA. Late stent thrombosis (LST) was defined as angiographic documentation of stent occlusion associated with an acute ischemic event, unexplained sudden D or MI not clearly attributable to another coronary lesion > 12 months post-procedure.ResultsUnstable angina at presentation was more frequent in group A pts (36% vs. 26%, p<0.05).The incidence of LST was 2.1% in group A and 0.8% in group B pts (p:ns); no difference was observed according to diabetic treatment (insulin vs. non-insulin dependent). At FU D was observed in 4.8% vs. 2.4%, MI 1.9% vs. 0.8%, and HDP in 8.4% vs. 4% between pts in group A and B respectively (p:ns). The rate of any REV and MACE was higher in pts in group A (20.3% vs. 6.3%, and 26.7% vs. 11.1%, p<0.001); this difference was only observed in non-insulin-dependent pts. In a multivariate model ejection fraction <40% was predictor for LST (HR 14.5, 95% CI 3.9-49.4, p<0.001), and D/MI (HR 3.61, 95% CI 1.7-7.5, p=0.001), and multivessel disease for MACE (HR 2.0,95% CI 1.27-3.15, p=0.003).ConclusionDual APLT > 12 months in DM pts treated with DES implantation is not associated with better clinical outcome or lower risk of LST