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Dual Antiplatelet T...
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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
Publisher, publication year, extent ...
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Elsevier BV,2019
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Numbers
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LIBRIS-ID:oai:DiVA.org:uu-379036
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-379036URI
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https://doi.org/10.1016/j.jacc.2018.11.048DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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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)
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Feres, FaustoIst Dante Pazzanese Cardiol, Sao Paulo, Brazil
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James, Stefan K,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)stjam367
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Raber, LorenzBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland
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Pilgrim, ThomasBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland
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Hong, Myeong-KiYonsei Univ, Coll Med, Severance Cardiovasc Hosp, Seoul, South Korea;Yonsei Univ, Severance Biomed Sci Inst, Coll Med, Seoul, South Korea
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Kim, Hyo-SooSeoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea
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Colombo, AntonioIst Sci San Raffaele, Intervent Cardiol Unit, Milan, Italy;EMO GVM Ctr Cuore Columbus, Intervent Cardiol Unit, Milan, Italy
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Steg, Philippe GabrielAP HP, FACT, Paris, France;Univ Paris Diderot, Bichat Hosp, Paris, France
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Bhatt, Deepak L.Brigham & Womens Hosp, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA;Harvard Med Sch, Boston, MA USA
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Stone, Gregg W.Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA;Cardiovasc Res Fdn, New York, NY USA
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Windecker, StephanBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland
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Steyerberg, Ewout W.Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
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Valgimigli, MarcoBern Univ Hosp, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland
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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
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In:Journal of the American College of Cardiology: Elsevier BV73:7, s. 741-7540735-10971558-3597
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Hong, Myeong-Ki
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