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Short Duration of D...
Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes
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- Laudani, Claudio (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Greco, Antonio (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Occhipinti, Giovanni (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Ingala, Salvatore (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Calderone, Dario (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Scalia, Lorenzo (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Agnello, Federica (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Legnazzi, Marco (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Mauro, Maria Sara (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Rochira, Carla (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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- Buccheri, Sergio (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Mehran, Roxana (author)
- Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA.
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- James, Stefan, 1964- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Angiolillo, Dominick J. (author)
- Univ Florida, Coll Med, Div Cardiol, Jacksonville, FL USA.
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- Capodanno, Davide (author)
- Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy.
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Univ Catania, Azienda Osped Univ Policlin G Rodolico San Marco, Div Cardiol, Catania, Italy Kardiologi (creator_code:org_t)
- Elsevier BV, 2022
- 2022
- English.
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In: JACC. - : Elsevier BV. - 1936-8798 .- 1876-7605. ; 15:3, s. 268-277
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- acute coronary syndrome(s)
- dual antiplatelet therapy
- network meta-analysis
- percutaneous coronary intervention
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Laudani, Claudio
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Greco, Antonio
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Occhipinti, Giov ...
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Ingala, Salvator ...
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Calderone, Dario
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Scalia, Lorenzo
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Agnello, Federic ...
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Legnazzi, Marco
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Mauro, Maria Sar ...
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Rochira, Carla
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Buccheri, Sergio
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Mehran, Roxana
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James, Stefan, 1 ...
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Angiolillo, Domi ...
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Capodanno, David ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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JACC
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Uppsala University