Reduced Mortality with Antiplatelet Therapy Deescalation after Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis

Tullio Palmerini, Antonio Giulio Bruno, Mauro Gasparini, Giulia Rizzello, Hyo Soo Kim, Jeehoon Kang, Kyung Woo Park, Joo Yong Hahn, Young Bin Song, Hyeon Cheol Gwon, Eun Ho Choo, Mahn Won Park, Chan Joon Kim, Kiyuk Chang, Thomas Cuisset, Nevio Taglieri, Byeong Keuk Kim, Yangsoo Jang, Elena Nardi, Francesco SaiaMatheusz Orzalkiewicz, Francesco Chietera, Gabriele Ghetti, Nazzareno Galiè, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Antiplatelet therapy deescalation has been suggested as an alternative to standard treatment with potent dual antiplatelet therapy (DAPT) for 1 year in low bleeding risk patients with acute coronary syndromes undergoing percutaneous coronary intervention to mitigate the increased risk of bleeding. Whether this strategy preserves the ischemic and survival benefits of potent DAPT is uncertain. Methods: We performed a pairwise meta-Analysis in patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with either 1-year standard potent DAPT versus deescalation therapy (potent DAPT for 1-3 months followed by either reduced potency DAPT or ticagrelor monotherapy for up to 1 year). Randomized trials comparing standard DAPT versus deescalation therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary end point was 1-year all-cause mortality. Results: The meta-Analysis included 6 trials in which 20 837 patients were randomized to potent DAPT for 1 to 3 months followed by deescalation therapy for up to 1 year (n=10 392) or standard potent DAPT for 1 year (n=10 445). Deescalation therapy was associated with lower 1-year rates of all-cause mortality compared with standard therapy (odds ratio, 0.75 [95% CI, 0.59-0.95]; P=0.02). Deescalation therapy was also associated with lower rates of major bleeding (odds ratio, 0.59 [95% CI, 0.48-0.72]; P<0.0001), with no significant difference in major adverse cardiac events (major adverse cardiovascular events; odds ratio, 0.89 [95% CI, 0.77-1.04]; P=0.14). Conclusions: In low bleeding risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, compared with 1-year of potent DAPT, antiplatelet therapy deescalation therapy after 1 to 3 months was associated with decreased mortality and major bleeding with similar rates of major adverse cardiovascular events.

Original languageEnglish
Pages (from-to)906-914
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume15
Issue number11
DOIs
StatePublished - 1 Nov 2022

Keywords

  • acute coronary syndrome
  • ischemia
  • mortality
  • percutaneous coronary intervention
  • stent

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