One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes
Year: 2024
Type: article
Abstract: BACKGROUND: A short dual antiplatelet therapy (DAPT) duration has been proposed for patients at high bleeding risk (HBR) undergoing drug-eluting coronary stent (DES) implantation. Whether this strategy is safe and effective after a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains uncertain. AIMS: We aimed to compare the impact of 1-month versus 3-month DAPT on clinical outcomes after DES implantation among HBR patients with or without NSTE-ACS. METHODS: This is a prespecified analysis from the XIENCE Short DAPT programme involving three prospective, international, single-arm studies evaluating the safety and efficacy of 1-month (XIENCE 28 USA and Global) or 3-month (XIENCE 90) DAPT among HBR patients after implantation of a cobalt-chromium everolimus-eluting stent. Ischaemic and bleeding outcomes associated with 1- versus 3-month DAPT were assessed according to clinical presentation using propensity score stratification. RESULTS: Of 3,364 HBR patients (1,392 on 1-month DAPT and 1,972 on 3-month DAPT), 1,164 (34.6%) underwent DES implantation for NSTE-ACS. At 12 months, the risk of the primary endpoint of death or myocardial infarction was similar between 1- and 3-month DAPT in patients with (hazard ratio [HR] 1.09, 95% confidence interval [CI]: 0.71-1.65) and without NSTE-ACS (HR 0.88, 95% CI: 0.63-1.23; p-interaction=0.34). The key secondary endpoint of Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding was consistently reduced in both NSTE-ACS (HR 0.57, 95% CI: 0.37-0.88) and stable patients (HR 0.84, 95% CI: 0.61-1.15; p-interaction=0.15) with 1-month DAPT. CONCLUSIONS: Among HBR patients undergoing implantation of an everolimus-eluting stent, 1-month, compared to 3-month DAPT, was associated with similar ischaemic risk and reduced bleeding at 1 year, irrespective of clinical presentation.
Source: EuroIntervention
Authors: Davide Cao, Pascal Vranckx, Marco Valgimigli, Samantha Sartori, Dominick J. Angiolillo, Sripal Bangalore, Deepak L. Bhatt, Yihan Feng, Junbo Ge, James Hermiller, Raj R. Makkar, Franz-Josef Neumann, Shigeru Saito, Hector Picon, Ralph Toelg, Aziz Maksoud, Bassem M. Chehab, James W. Choi, Gianluca Campo, José M. De la Torre Hernandez, Mitchell W. Krucoff, Vijay Kunadian, Gennaro Sardella, Alessandro Spirito, Holger Thiele, Olivier Varenne, Birgit Vogel, Yujie Zhou, Stephan Windecker, Roxana Mehran
Institutions: Humanitas University, Icahn School of Medicine at Mount Sinai, Hartcentrum Hasselt, Hasselt University, University Hospital of Bern, Ente Ospedaliero Cantonale, Istituto Cardiocentro Ticino, University of Florida, NYU Langone Health, Fudan University, Zhongshan Hospital, St Vincent Hospital, Cedars-Sinai Medical Center, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Shonan Kamakura General Hospital, American University of Rome, Segeberger Kliniken, University of Kansas, Ascension Via Christi Hospital, Ascension Via Christi, Texas Health Dallas, Arcispedale Sant'Anna, Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Duke Medical Center, Duke Clinical Research Institute, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle University, Policlinico Umberto I, Leipzig Heart Institute, Leipzig University, Hôpital Cochin, Beijing Anzhen Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: American Heart Association, AstraZeneca, Bayer, CSL Behring, Cedars-Sinai Medical Center, Inselspital, Universitätsspital Bern, Belvoir Media Group, York University, Newcastle University, Daiichi-Sankyo, Fudan University, Newcastle upon Tyne Hospitals NHS Foundation Trust, Humanitas University, Instituto de Investigación Marqués de Valdecilla, National Institutes of Health, School of Medicine, University of Kansas, Abbott Vascular, Duke Clinical Research Institute, Daiichi Sankyo Europe
OpenAlex ID: W4397023830