TY - JOUR
T1 - 1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI
AU - Valgimigli, Marco
AU - Spirito, Alessandro
AU - Sartori, Samantha
AU - Angiolillo, Dominick J.
AU - Vranckx, Pascal
AU - de la Torre Hernandez, Jose M.
AU - Krucoff, Mitchell W.
AU - Bangalore, Sripal
AU - Bhatt, Deepak L.
AU - Campo, Gianluca
AU - Cao, Davide
AU - Chehab, Bassem M.
AU - Choi, James W.
AU - Feng, Yihan
AU - Ge, Junbo
AU - Hermiller, James
AU - Kunadian, Vijay
AU - Lupo, Sydney
AU - Makkar, Raj R.
AU - Maksoud, Aziz
AU - Neumann, Franz Josef
AU - Picon, Hector
AU - Saito, Shigeru
AU - Sardella, Gennaro
AU - Thiele, Holger
AU - Toelg, Ralph
AU - Varenne, Olivier
AU - Vogel, Birgit
AU - Zhou, Yujie
AU - Windecker, Stephan
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/10/23
Y1 - 2023/10/23
N2 - Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain. Objectives: The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program. Methods: The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. Results: Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS). Conclusions: Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment.
AB - Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain. Objectives: The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program. Methods: The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. Results: Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS). Conclusions: Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment.
KW - dual antiplatelet therapy
KW - everolimus-eluting stent(s)
KW - high bleeding risk
KW - oral anticoagulant therapy
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85173941845&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2023.08.014
DO - 10.1016/j.jcin.2023.08.014
M3 - Article
C2 - 37804290
AN - SCOPUS:85173941845
SN - 1936-8798
VL - 16
SP - 2498
EP - 2510
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 20
ER -