Optimal Dual Antiplatelet Therapy Duration for Bioresorbable Scaffolds: an Individual Patient Data Pooled Analysis of the ABSORB Trials.

Background Compared with everolimus-eluting metallic stents, the Absorb bioresorbable scaffold (BRS) results in increased rates of myocardial infarction (MI) and scaffold thrombosis (ST) during its 3-year bioresorption phase. It is unknown whether prolonged dual antiplatelet therapy (DAPT) duration might decrease the risk of ischemic events. Aims We sought to evaluate the impact of DAPT duration on ischemic and bleeding outcomes following BRS implantation. Methods We conducted an individual patient-data pooled analysis from 4 ABSORB randomized trials and 1 prospective ABSORB registry. Study endpoints were MI, ST, bleeding, and death through 3-year follow-up. Propensity score-adjusted Cox regression analysis was used to account for baseline differences related to DAPT duration. Results The five ABSORB studies included 2,973 patients. DAPT use was 91.7%, 53.2%, and 48.0% at 1, 2, and 3 years, respectively. DAPT use within the first year after BRS implantation was associated with markedly lower risks of MI (adjusted hazard ratio [aHR] 0.17, 95%CI 0.10-0.32, pl0.0001) and ST (aHR 0.08, 95%CI 0.03-0.19, pl0.0001). Conversely, DAPT use between 1 and 3 years did not significantly affect the risk of MI (aHR 1.04, 95%CI 0.70-1.55, p=0.84) or ST (aHR 0.86, 95%CI 0.42-1.75, p=0.67). DAPT did not have major effects upon bleeding or death in either period. Conclusions DAPT use during the first year after BRS implantation was strongly associated with lower risks of ST and MI. However, a benefit of ongoing DAPT use between 1 and 3 years after BRS implantation was not apparent.