1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI

Marco Valgimigli; Alessandro Spirito; Samantha Sartori; Dominick J. Angiolillo; Pascal Vranckx; Jose M. de la Torre Hernandez; Mitchell W. Krucoff; Sripal Bangalore; Deepak L. Bhatt; Gianluca Campo; Davide Cao; Bassem M. Chehab; James W. Choi; Yihan Feng; Junbo Ge; James Hermiller; Vijay Kunadian; Sydney Lupo; Raj R. Makkar; Aziz Maksoud; Franz Josef Neumann; Hector Picon; Shigeru Saito; Gennaro Sardella; Holger Thiele; Ralph Toelg; Olivier Varenne; Birgit Vogel; Yujie Zhou; Stephan Windecker; Roxana Mehran

doi:10.1016/j.jcin.2023.08.014

1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI

Marco Valgimigli
, Alessandro Spirito
, Samantha Sartori
, Dominick J. Angiolillo
, Pascal Vranckx
, Jose M. de la Torre Hernandez
, Mitchell W. Krucoff
, Sripal Bangalore
, Deepak L. Bhatt
, Gianluca Campo
, Davide Cao
, Bassem M. Chehab
, James W. Choi
, Yihan Feng
, Junbo Ge
, James Hermiller
, Vijay Kunadian
, Sydney Lupo
, Raj R. Makkar
, Aziz Maksoud

Franz Josef Neumann, Hector Picon, Shigeru Saito, Gennaro Sardella, Holger Thiele, Ralph Toelg, Olivier Varenne, Birgit Vogel, Yujie Zhou, Stephan Windecker, Roxana Mehran

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	2498-2510
Number of pages	13
Journal	JACC: Cardiovascular Interventions
Volume	16
Issue number	20
DOIs	https://doi.org/10.1016/j.jcin.2023.08.014
State	Published - 23 Oct 2023

Keywords

dual antiplatelet therapy
everolimus-eluting stent(s)
high bleeding risk
oral anticoagulant therapy
percutaneous coronary intervention

Access to Document

10.1016/j.jcin.2023.08.014

Cite this

Valgimigli, M., Spirito, A., Sartori, S., Angiolillo, D. J., Vranckx, P., de la Torre Hernandez, J. M., Krucoff, M. W., Bangalore, S., Bhatt, D. L., Campo, G., Cao, D., Chehab, B. M., Choi, J. W., Feng, Y., Ge, J., Hermiller, J., Kunadian, V., Lupo, S., Makkar, R. R., ... Mehran, R. (2023). 1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI. JACC: Cardiovascular Interventions, 16(20), 2498-2510. https://doi.org/10.1016/j.jcin.2023.08.014

@article{1e5d405e68384d61a14f4fce3d227ea3,

title = "1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI",

abstract = "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.",

keywords = "dual antiplatelet therapy, everolimus-eluting stent(s), high bleeding risk, oral anticoagulant therapy, percutaneous coronary intervention",

author = "Marco Valgimigli and Alessandro Spirito and Samantha Sartori and Angiolillo, \{Dominick J.\} and Pascal Vranckx and \{de la Torre Hernandez\}, \{Jose M.\} and Krucoff, \{Mitchell W.\} and Sripal Bangalore and Bhatt, \{Deepak L.\} and Gianluca Campo and Davide Cao and Chehab, \{Bassem M.\} and Choi, \{James W.\} and Yihan Feng and Junbo Ge and James Hermiller and Vijay Kunadian and Sydney Lupo and Makkar, \{Raj R.\} and Aziz Maksoud and Neumann, \{Franz Josef\} and Hector Picon and Shigeru Saito and Gennaro Sardella and Holger Thiele and Ralph Toelg and Olivier Varenne and Birgit Vogel and Yujie Zhou and Stephan Windecker and Roxana Mehran",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Cardiology Foundation",

year = "2023",

month = oct,

day = "23",

doi = "10.1016/j.jcin.2023.08.014",

language = "English",

volume = "16",

pages = "2498--2510",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "20",

}

Valgimigli, M, Spirito, A, Sartori, S, Angiolillo, DJ, Vranckx, P, de la Torre Hernandez, JM, Krucoff, MW, Bangalore, S, Bhatt, DL, Campo, G, Cao, D, Chehab, BM, Choi, JW, Feng, Y, Ge, J, Hermiller, J, Kunadian, V, Lupo, S, Makkar, RR, Maksoud, A, Neumann, FJ, Picon, H, Saito, S, Sardella, G, Thiele, H, Toelg, R, Varenne, O, Vogel, B, Zhou, Y, Windecker, S & Mehran, R 2023, '1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI', JACC: Cardiovascular Interventions, vol. 16, no. 20, pp. 2498-2510. https://doi.org/10.1016/j.jcin.2023.08.014

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

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 - https://www.scopus.com/pages/publications/85173941845

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 -

1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI

Abstract

Keywords

Access to Document

Fingerprint

Cite this