Optimal duration for dual antiplatelet therapy with COMBO dual therapy stent

Abstract

The COMBO stent (OrbusNeich Medical BV, the Netherlands) is a stainless-steel platform with the biodegradable abluminal coating containing antiproliferative sirolimus (5 mg/mm) and the luminal stent surface covered with antiCD-34 antibody. The CD-34 antibodies essentially capture endothelial progenitor cells resulting in rapid re-endothelialization of the treated segment. This characteristic was initially demonstrated in in-vitro models, and its safety proven in the larger randomized clinical trials with dual therapy stents. The REMEDEE (Randomized study to Evaluate the safety and effectiveness of an abluMinal sirolimuscoatED bio-Engineered StEnt) Trial was the first human trial comparing COMBO stents to the paclitaxel drug eluting stents (Taxus Liberte, Boston Scientific, Marlborough, Massachusetts). High initial procedural success, low revascularization rates, and low stent thrombosis rates were observed in all these patient populations. The trial protocol dictated a dual antiplatelet therapy (DAPT) for a duration of 6 months in elective cases and for 12 months in patients diagnosed with an acute coronary syndrome (ACS). DAPTs bear the risk of bleeding events after successful percutaneous coronary intervention (PCI) and are independently associated with an increased mortality and morbidity. The European Society of Cardiology (ESC) Guidelines on dual antiplatelet therapy in coronary artery disease (CAD) currently encourage every effort in minimizing such bleeding complications, and an optimized DAPT regimen is inherent in circumventing this risk. \uf020 Several studies investigated the use of DAPT (ASA and clopidogrel) for three months in patients with stable CAD. However, these trials used the Endeavor zotarolimus-eluting stent in the 3-month DAPT arms. We hypothesised that the novel characteristics of the