One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes

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

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: A short dual antiplatelet therapy (DAPT) duration has been proposed for patients at high bleeding risk (HBR) undergoing drug-eluting coronary stent (DES) implantation. Whether this strategy is safe and effective after a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains uncertain. AIMS: We aimed to compare the impact of 1-month versus 3-month DAPT on clinical outcomes after DES implantation among HBR patients with or without NSTE-ACS. METHODS: This is a prespecified analysis from the XIENCE Short DAPT programme involving three prospective, international, single-arm studies evaluating the safety and efficacy of 1-month (XIENCE 28 USA and Global) or 3-month (XIENCE 90) DAPT among HBR patients after implantation of a cobalt-chromium everolimus-eluting stent. Ischaemic and bleeding outcomes associated with 1- versus 3-month DAPT were assessed according to clinical presentation using propensity score stratification. RESULTS: Of 3,364 HBR patients (1,392 on 1-month DAPT and 1,972 on 3-month DAPT), 1,164 (34.6%) underwent DES implantation for NSTE-ACS. At 12 months, the risk of the primary endpoint of death or myocardial infarction was similar between 1- and 3-month DAPT in patients with (hazard ratio [HR] 1.09, 95% confidence interval [CI]: 0.71-1.65) and without NSTE-ACS (HR 0.88, 95% CI: 0.63-1.23; p-interaction=0.34). The key secondary endpoint of Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding was consistently reduced in both NSTE-ACS (HR 0.57, 95% CI: 0.37-0.88) and stable patients (HR 0.84, 95% CI: 0.61-1.15; p-interaction=0.15) with 1-month DAPT. CONCLUSIONS: Among HBR patients undergoing implantation of an everolimus-eluting stent, 1-month, compared to 3-month DAPT, was associated with similar ischaemic risk and reduced bleeding at 1 year, irrespective of clinical presentation.

Original languageEnglish
Pages (from-to)e630-e642
JournalEuroIntervention
Volume20
Issue number10
DOIs
StatePublished - 2024

Keywords

  • ACS/NSTE-ACS
  • adjunctive pharmacotherapy
  • bleeding
  • drug-eluting stent
  • myocardial infarction

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