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Lookup NU author(s): Professor Vijay KunadianORCiD
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© 2024 Elsevier Inc.Shortening the duration of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) was shown to be effective and safe in patients at high bleeding risk (HBR). We aimed to investigate the effect of 1 versus 3-month DAPT on outcomes after drug-eluting stent in HBR patients with or without chronic kidney disease (CKD). Data from 3 prospective single-arm studies (XIENCE Short DAPT Program) enrolling HBR patients after successful coronary implantation of cobalt-chromium everolimus-eluting stent (XIENCE, Abbott) were analyzed. Subjects were eligible for DAPT discontinuation at 1 or 3 months if free from ischemic events. The primary end point was all-cause death or any myocardial infarction. The key secondary end point was Bleeding Academic Research Consortium Type 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after PCI. CKD was defined as baseline creatinine clearance <60 ml/min. Of 3,286 patients, 1,432 (43.6%) had CKD. One-month versus 3-month DAPT was associated with a similar 12-month risk of the primary outcome irrespective of CKD status (CKD: 9.5% vs 10.9%, adjusted hazard ratio 0.86, 95% confidence interval 0.60 to 1.22; no-CKD: 6.6% vs 5.6%, adjusted hazard ratio 1.15, 95% confidence interval 0.77 to 1.73; p interaction 0.299). Bleeding Academic Research Consortium 2 to 5 bleeding rates were numerically but not significantly lower with 1-month versus 3-month DAPT in both CKD (9.9% vs 12%) and no-CKD (6.4% vs 9.0%) patients. In conclusion, in HBR patients, 1-month versus 3-month DAPT was associated with a similar risk of ischemic complications and a trend toward fewer bleeding events at 12 months after PCI, irrespective of CKD status.
Author(s): Mankerious N, Toelg R, Vogel B, Sartori S, Angiolillo DJ, Vranckx P, Feng Y, de la Torre Hernandez JM, Krucoff MW, Bhatt DL, Spirito A, Cao D, Chehab BM, Kunadian V, Maksoud A, Picon H, Sardella G, Thiele H, Varenne O, Windecker S, Richardt G, Valgimigli M, Mehran R
Publication type: Article
Publication status: Published
Journal: American Journal of Cardiology
Year: 2024
Volume: 225
Pages: 25-34
Print publication date: 15/08/2024
Online publication date: 11/06/2024
Acceptance date: 24/05/2024
ISSN (print): 0002-9149
ISSN (electronic): 1879-1913
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.amjcard.2024.06.003
DOI: 10.1016/j.amjcard.2024.06.003
PubMed id: 38871156
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