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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ETwo years of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation is no better than 6 months of DAPT in preventing adverse cardiac events, according to the Prolonging dual antiplatelet treatment after Grading Stent-Induced Intima Hyperplasia Study [PRODIGY; NCT000611286].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ETwo years of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is no better than 6 months of DAPT in preventing adverse cardiac events, according to the Prolonging dual antiplatelet treatment after Grading Stent-Induced Intima Hyperplasia Study [PRODIGY; NCT000611286]. Marco Valgimigli, MD, PhD, University of Ferrara, Ferrara, Italy, reported the main results of the PRODIGY trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPRODIGY was an open-label, three-center, randomized, factorial assignment clinical trial to assess the efficacy and safety of prolonged DAPT (up to 2 years) with aspirin and clopidogrel after coronary stenting compared with currently recommended DAPT regimens (a minimum of 1 month after bare-metal stent [BMS] or 6 months after DES).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EInclusion criteria included males and females aged \u226518 years with coronary artery disease with low-, intermediate-, or high-risk coronary anatomy who were considered suitable for percutaneous coronary intervention with stent placement. The primary outcome was the composite endpoint of death, myocardial infarction (MI), or stroke, occurring from 31 days up to 24 months after intervention. The primary safety outcome was Bleeding Academic Research Consortium (BARC) type 2, 3, and 5 bleeding (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Mehran R et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12443\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12443\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12443\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EBARC Definitions.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EPatients (n=1970) who were scheduled for elective, urgent, or emergency coronary angioplasties were initially randomized in a 1:1:1:1 fashion to one of four stent types: everolimus-eluting stent, paclitaxel-eluting stent, zotarolimus-eluting stent, or third-generation thin-strut BMS. At 30 days, patients in each stent group were then further randomized to either 6 or 24 months of DAPT to ensure that the length of DAPT was equally distributed within each of the four stent groups.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EResults showed that the cumulative risk of the primary outcome at 2 years was 10.1% with the 24-month treatment and 10.0% with the 6-month treatment (HR, 0.98; 95% CI, 0.74 to 1.29; p=0.91). The individual risks of death, MI, cerebrovascular accident, or stent thrombosis did not differ between the two groups.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EPatients who received long-term DAPT had a roughly 2-fold greater risk of BARC (2, 3, or 5) bleeding events (HR, 2.17; 95% CI, 1.44 to 3.22; p=0.00018). The risks of TIMI-defined major bleeding (p=0.04) and red blood cell transfusion (p=0.04) were also increased in the 24-month clopidogrel group.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn patients who received first- or second-generation DES, outcomes failed to show a benefit of DAPT treatment for 24 months. According to Prof. Valgimigli, \u201cWhile we cannot rule out the possibility that a smaller-than-previously anticipated benefit may exist, the clear increase in bleeding, transfusion, and net adverse clinical events suggests that current recommendations may have overemphasized the benefit over the risk of long-term treatment with aspirin and clopidogrel.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThese findings question the validity of current guideline recommendations, which were based on registry data. According to Prof. Valgimigli, if the risk of morbidity due to bleeding outweighs the anticipated benefit that is afforded by thienopyridine therapy, earlier discontinuation should be considered [Duke Heart Registry; \u003Cem\u003EJAMA\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/10\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmyrp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmyrp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}