STOP-DAPT 2 ACS: 1 month DAPT followed by clopidogrel monotherapy does not quite cut it when it comes to ACS

Key Points:

The original STOP-DAPT trial randomized patients to receive either 12 months of dual antiplatelet therapy after percutaneous coronary intervention or one month of dual antiplatelet therapy followed by clopidogrel monotherapy, and found significantly less cardiovascular and bleeding events in the shorter DAPT group.
As only 38% of the participants of the original STOP-DAPT 2 trial had acute coronary syndrome (ACS), STOP-DAPT 2 ACS was designed to assess the outcomes of a shorter DAPT duration in patients with ACS.
After pooling patients from STOP-DAPT 2 and STOP-DAPT 2 ACS, one month of DAPT failed to meet noninferiority when compared to 12 months for a composite outcome of cardiovascular and bleeding events.
Participants who received one month of DAPT had a trend toward higher cardiovascular events yet lower bleeding events, as would be expected.

ILR use led to increased diagnosis of Atrial Fibrillation, but no reduction in stroke or arterial embolism noted: Results from LOOP

Key Points:

• In the LOOP trial, patients at high risk of stroke were randomized to either implantable loop recorder (ILR) versus usual care.
• The primary endpoint was time to stroke or arterial embolism, and secondary outcomes included a) combined ischemic stroke, systemic arterial embolism, and TIA, b) combined stroke, systemic arterial embolism, and CV death, and c) all-cause mortality. Other outcomes of interest included atrial fibrillation (AF) diagnosis and oral anticoagulant use.

• The use of ILR resulted in a three-fold increase in AF detection and initiation of anticoagulation, but there was no observed reduction in the primary endpoint of stroke or systemic arterial embolism.
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Systematic FFR in patients undergoing coronary angiography did not improve outcomes at 1 year: Results from RIPCORD-2.

Key Points:

Patients undergoing coronary angiography were randomized to undergo fractional flow reserve pressure wiring of all lesions with >30% stenosis amenable to stenting versus coronary angiography alone.
After enrollment of 1,100 patients and one year of follow up there was no difference in the primary outcome of total hospital cost or quality of life and angina status.
While there were no differences in any of the prespecified secondary outcomes, including death, stroke and unplanned revascularization, almost 15% of patients undergoing coronary angiography alone required further testing to determine lesion significance.

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