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  • Laudani, ClaudioUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)

Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes

  • Article/chapterEnglish2022

Publisher, publication year, extent ...

  • Elsevier BV,2022
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-470541
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-470541URI
  • https://doi.org/10.1016/j.jcin.2021.11.028DOI

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  • Language:English
  • Summary in:English

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

Notes

  • OBJECTIVES: The aim of this study was to compare short dual antiplatelet therapy (DAPT) and de-escalation in a network meta-analysis using standard DAPT as common comparator.BACKGROUND: In patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), shortening DAPT and de-escalating to a lower potency regimen mitigate bleeding risk. These strategies have never been randomly compared.METHODS: Randomized trials of DAPT modulation strategies in patients with ACS undergoing PCI were identified. All cause death was the primary outcome. Secondary outcomes included net adverse cardiovascular events (NACE), major adverse cardiovascular events, and their components. Frequentist and Bayesian network meta-analyses were conducted. Treatments were ranked on the basis of posterior probability. Sensitivity analyses were performed to explore sources of heterogeneity.RESULTS: Twenty-nine studies encompassing 50,602 patients were included. The transitivity assumption was fulfilled. In the frequentist indirect comparison, the risk ratio (RR) for all-cause death was 0.98 (95% CI: 0.68-1.43). De-escalation reduced the risk for NACE (RR: 0.87; 95% CI: 0.70-0.94) and increased major bleeding (RR: 1.54; 95% CI: 1.07-2.21). These results were consistent in the Bayesian meta-analysis. De-escalation displayed a >95% probability to rank first for NACE, myocardial infarction, stroke, stent thrombosis, and minor bleeding, while short DAPT ranked first for major bleeding. These findings were consistent in node-split and multiple sensitivity analyses.CONCLUSIONS: In patients with ACS undergoing PCI, there was no difference in all-cause death between short DAPT and de-escalation. De-escalation reduced the risk for NACE, while short DAPT decreased major bleeding. These data characterize 2 contemporary strategies to personalize DAPT on the basis of treatment objectives and risk profile.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Greco, AntonioUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Occhipinti, GiovanniUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Ingala, SalvatoreUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Calderone, DarioUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Scalia, LorenzoUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Agnello, FedericaUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Legnazzi, MarcoUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Mauro, Maria SaraUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Rochira, CarlaUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Buccheri, SergioUppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)serbu677 (author)
  • Mehran, RoxanaIcahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA. (author)
  • James, Stefan,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)stjam367 (author)
  • Angiolillo, Dominick J.Univ Florida, Coll Med, Div Cardiol, Jacksonville, FL USA. (author)
  • Capodanno, DavideUniv Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy. (author)
  • Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.Kardiologi (creator_code:org_t)

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  • In:JACC: Elsevier BV15:3, s. 268-2771936-87981876-7605

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