Myocardial infarction patients who undergo percutaneous coronary intervention and stenting do not have more adverse events at 3 months than at 12 months of dual antiplatelet therapy. This is the main finding of the REDUCE trial which was presented by prof. Harry Suryapranata (Radboudumc) during the TCT congress in Denver.

The optimal duration of dual antiplatelet therapy after stenting in patients with a myocardial infarction is currently under debate. The difficulty lies  in finding the right balance between thrombotic and bleeding complications. A long treatment with dual antiplatelet therapy decreases the risk of thrombotic complications (myocardial infarction, stent thrombosis). However, it increases the bleeding risk. The currently recommended guideline of  12-month dual antiplatelet therapy is predominantly based on trials with older stents.

Complications not statistically different in both groups

The REDUCE trial [NCT02118870] was conducted in 36 hospitals in Europe and Asia, enrolling a total of 1500 ACS patients. These patients were successfully treated with a COMBO stent. COMBO is the world’s first and only dual therapy stent designed to repair vessel injury and regenerate the endothelium. Thus fostering natural and true vessel healing. Patients were randomized during index hospitalization to either 3-month or to 12-month dual antiplatelet therapy. “The results show that after COMBO stenting 3-month dual antiplatelet therapy is non-inferior to 12-month dual antiplatelet therapy”, said prof. Harry Suryapranata, principal investigator and professor of intervention cardiology Radboudumc. “In approximately one out of twelve patients one of the following complications occurred in the first year: all-cause mortality, myocardial infarction, stent thrombosis, stroke, repeated revascularization or bleeding”.

Contribution Radboudumc

The REDUCE trial was conducted at the Radboudumc by Cyril Camaro, intervention cardiologist, and Sander Damen, PhD candidate. Camaro: “the trial shows that a shorter duration of dual antiplatelet therapy can be considered if necessary even in patients with a myocardial infarction”. Suryapranata, who presented the results at the TCT congress in Denver: “It is a very important study, however future large trials are needed to further investigate and confirm the safety of short-term dual antiplatelet regimen in these patients in the era of new antiplatelet therapies”.

References

*Suryapranata H, De Luca G. REDUCE: A Randomized Trial of 3-Month vs 12-Month DAPT After Implantation of a Bioabsorbable Polymer-Based Metallic DES with a Luminal CD34+Antibody Coating in Patients with ACS. Oral presentation at the 29th annual Transcatheter Cardiovascular Therapeutics scientific symposium, November 1, 2017.

*TCT congress: www.tctmd.com/news/shortened-dapt-durations-appear-safe-patients-acs-implanted-des