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Lookup NU author(s): Professor Vijay KunadianORCiD
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© 2025 American College of Cardiology FoundationBackground: In patients at high bleeding risk (HBR), short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is associated with reduced bleeding and preserved ischemic protection. Objectives: The aim of this study was to compare 2 short DAPT regimens, followed by aspirin monotherapy, in women and men at HBR undergoing PCI. Methods: Data from 3 prospective, international studies (XIENCE Short DAPT Program) including patients at HBR undergoing PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (XIENCE) were analyzed. The primary endpoint was the composite of death or myocardial infarction (MI) at 1 year. The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Results: Among 3,364 patients, 1,154 (34.3%) were women. At 1 year, the rates of death or MI (7.6% vs 8.1%) and BARC types 2 to 5 bleeding (9.5% vs 9.2%) were similar in women and men. One-month and 3-month DAPT conferred a similar risk for death or MI in women (adjusted HR: 0.86; 95% CI: 0.54-1.36) and men (adjusted HR: 1.04; 95% CI: 0.75-1.44) (P for interaction = 0.783). In both sexes, BARC types 2 to 5 bleeding was numerically lower with 1-month DAPT, although not significant after propensity score stratification (women: 7.1% vs 11.2%; adjusted HR: 0.66; 95% CI: 0.43-1.02; men: 8.5% vs 9.7%; adjusted HR: 0.78; 95% CI: 0.57-1.06) (P for interaction = 0.378). Conclusions: Among patients at HBR undergoing PCI with everolimus-eluting stents, 1- and 3-month DAPT was associated with similar risk for ischemic events irrespective of sex. In both women and men, 1-month DAPT resulted in less clinically relevant bleeding, although the bleeding risk difference was not significant after propensity score stratification.
Author(s): Kunadian V, Gitto M, Vogel B, Sartori S, Angiolillo DJ, Bhatt DL, Chehab BM, Feng Y, de la Torre Hernandez JM, Krucoff MW, Maksoud A, Mankerious N, Oliva A, Picon H, Richardt G, Sardella G, Thiele H, Toelg R, Varenne O, Vranckx P, Windecker S, Valgimigli M, Mehran R
Publication type: Article
Publication status: Published
Journal: JACC: Cardiovascular Interventions
Year: 2025
Volume: 18
Issue: 7
Pages: 866-878
Print publication date: 14/04/2025
Online publication date: 19/02/2025
Acceptance date: 08/01/2025
ISSN (print): 1936-8798
ISSN (electronic): 1876-7605
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.jcin.2025.01.424
DOI: 10.1016/j.jcin.2025.01.424
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