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  • Costa, FrancescoUniv Messina, Dept Clin & Expt Med, Policlin G Martino, Messina, Italy;Bern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland (author)

Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting

  • Article/chapterEnglish2019

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  • Elsevier BV,2019
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-379036
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-379036URI
  • https://doi.org/10.1016/j.jacc.2018.11.048DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • BACKGROUNDComplex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short-or long-term DAPT should be prioritized.OBJECTIVESThis study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PREdicting bleeding Complications in patients undergoing stent Implantation and SubsequEnt Dual AntiPlatelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting.METHODSComplex PCI was defined as $ 3 stents implanted and/or $ 3 lesions treated, bifurcation stenting and/or stent length > 60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high ($ 25) or nonhigh (< 25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT.RESULTSAmong 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference:-3.86%; 95% confidence interval:-7.71 to thorn0.06) and noncomplex PCI strata (absolute risk difference:-1.14%; 95% confidence interval:-2.26 to-0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity.CONCLUSIONS Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT.

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  • Van Klaveren, DavidLeiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands;Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA 02111 USA (author)
  • Feres, FaustoIst Dante Pazzanese Cardiol, Sao Paulo, Brazil (author)
  • James, Stefan K,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)stjam367 (author)
  • Raber, LorenzBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland (author)
  • Pilgrim, ThomasBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland (author)
  • Hong, Myeong-KiYonsei Univ, Coll Med, Severance Cardiovasc Hosp, Seoul, South Korea;Yonsei Univ, Severance Biomed Sci Inst, Coll Med, Seoul, South Korea (author)
  • Kim, Hyo-SooSeoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea (author)
  • Colombo, AntonioIst Sci San Raffaele, Intervent Cardiol Unit, Milan, Italy;EMO GVM Ctr Cuore Columbus, Intervent Cardiol Unit, Milan, Italy (author)
  • Steg, Philippe GabrielAP HP, FACT, Paris, France;Univ Paris Diderot, Bichat Hosp, Paris, France (author)
  • Bhatt, Deepak L.Brigham & Womens Hosp, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA;Harvard Med Sch, Boston, MA USA (author)
  • Stone, Gregg W.Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA;Cardiovasc Res Fdn, New York, NY USA (author)
  • Windecker, StephanBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland (author)
  • Steyerberg, Ewout W.Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands (author)
  • Valgimigli, MarcoBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland (author)
  • Univ Messina, Dept Clin & Expt Med, Policlin G Martino, Messina, Italy;Bern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, SwitzerlandLeiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands;Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA 02111 USA (creator_code:org_t)

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  • In:Journal of the American College of Cardiology: Elsevier BV73:7, s. 741-7540735-10971558-3597

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