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Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline.
Cardiovasc Drugs Ther. 2020 Jun 29 [Online ahead of print]CD

Abstract

PURPOSE

The ischemic/bleeding trade-off of continuing dual antiplatelet therapy (DAPT) beyond 1 year after PCI for patients with high thrombotic risk (HTR) as endorsed by 2018 ESC/EACTS myocardial revascularization guidelines remain unknown.

METHODS

Patients undergoing coronary stenting between January 2013 and December 2013 from the prospective Fuwai registry were defined as HTR if they met at least 1 ESC/EACTS guideline-endorsed HTR criteria. A total of 4578 patients who were at HTR and were events free at 1 year after the index procedure were evaluated. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause death, myocardial infarction, or stroke).

RESULTS

Median follow-up period was 2.4 years. > 1-year DAPT with clopidogrel and aspirin significantly reduced the risk of MACCE compared with ≤ 1-year DAPT (1.9% vs. 4.6%; hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.27-0.54; P < 0.001), driven by a reduction in all-cause death (0.2% vs. 3.0%; HR, 0.07; 95% CI, 0.03-0.15). Cardiac death and definite/probable stent thrombosis also occurred less frequently in prolonged DAPT group. Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred similarly between both groups (1.1% vs. 0.9%; HR, 1.11; 95% CI, 0.58-2.13; P = 0.763). Similar results were found using multivariable Cox model, propensity score-matched, and inverse probability of treatment weighting analysis.

CONCLUSIONS

Among patients with ESC-endorsed HTR who were free from major ischemic or bleeding events 1 year after coronary stenting, continued DAPT beyond 1 year might offer better effectiveness in terms of atherothrombotic events and comparable safety in terms of clinically relevant bleeding compared with ≤ 1-year DAPT. ESC-HTR criteria is an important parameter to take into account in tailoring DAPT prolongation.

Authors+Show Affiliations

Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. State Key Laboratory of Cardiovascular Disease, Beijing, China. National Clinical Research Center for Cardiovascular Diseases, Beijing, China.Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. doukefei@fuwaihospital.org. State Key Laboratory of Cardiovascular Disease, Beijing, China. doukefei@fuwaihospital.org. National Clinical Research Center for Cardiovascular Diseases, Beijing, China. doukefei@fuwaihospital.org.Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. National Clinical Research Center for Cardiovascular Diseases, Beijing, China.National Clinical Research Center for Cardiovascular Diseases, Beijing, China. Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. National Clinical Research Center for Cardiovascular Diseases, Beijing, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32601780

Citation

Wang, Hao-Yu, et al. "Benefit-Risk Profile of DAPT Continuation Beyond 1 Year After PCI in Patients With High Thrombotic Risk Features as Endorsed By 2018 ESC/EACTS Myocardial Revascularization Guideline." Cardiovascular Drugs and Therapy, 2020.
Wang HY, Dou KF, Wang Y, et al. Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline. Cardiovasc Drugs Ther. 2020.
Wang, H. Y., Dou, K. F., Wang, Y., Yin, D., Xu, B., & Gao, R. L. (2020). Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline. Cardiovascular Drugs and Therapy. https://doi.org/10.1007/s10557-020-07030-9
Wang HY, et al. Benefit-Risk Profile of DAPT Continuation Beyond 1 Year After PCI in Patients With High Thrombotic Risk Features as Endorsed By 2018 ESC/EACTS Myocardial Revascularization Guideline. Cardiovasc Drugs Ther. 2020 Jun 29; PubMed PMID: 32601780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline. AU - Wang,Hao-Yu, AU - Dou,Ke-Fei, AU - Wang,Yang, AU - Yin,Dong, AU - Xu,Bo, AU - Gao,Run-Lin, Y1 - 2020/06/29/ PY - 2020/06/22/accepted PY - 2020/7/1/entrez KW - Bleeding KW - Drug-eluting stents KW - Dual antiplatelet therapy KW - High thrombotic risk KW - Percutaneous coronary intervention KW - Risk assessment JF - Cardiovascular drugs and therapy JO - Cardiovasc Drugs Ther N2 - PURPOSE: The ischemic/bleeding trade-off of continuing dual antiplatelet therapy (DAPT) beyond 1 year after PCI for patients with high thrombotic risk (HTR) as endorsed by 2018 ESC/EACTS myocardial revascularization guidelines remain unknown. METHODS: Patients undergoing coronary stenting between January 2013 and December 2013 from the prospective Fuwai registry were defined as HTR if they met at least 1 ESC/EACTS guideline-endorsed HTR criteria. A total of 4578 patients who were at HTR and were events free at 1 year after the index procedure were evaluated. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause death, myocardial infarction, or stroke). RESULTS: Median follow-up period was 2.4 years. > 1-year DAPT with clopidogrel and aspirin significantly reduced the risk of MACCE compared with ≤ 1-year DAPT (1.9% vs. 4.6%; hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.27-0.54; P < 0.001), driven by a reduction in all-cause death (0.2% vs. 3.0%; HR, 0.07; 95% CI, 0.03-0.15). Cardiac death and definite/probable stent thrombosis also occurred less frequently in prolonged DAPT group. Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred similarly between both groups (1.1% vs. 0.9%; HR, 1.11; 95% CI, 0.58-2.13; P = 0.763). Similar results were found using multivariable Cox model, propensity score-matched, and inverse probability of treatment weighting analysis. CONCLUSIONS: Among patients with ESC-endorsed HTR who were free from major ischemic or bleeding events 1 year after coronary stenting, continued DAPT beyond 1 year might offer better effectiveness in terms of atherothrombotic events and comparable safety in terms of clinically relevant bleeding compared with ≤ 1-year DAPT. ESC-HTR criteria is an important parameter to take into account in tailoring DAPT prolongation. SN - 1573-7241 UR - https://www.unboundmedicine.com/medline/citation/32601780/Benefit-Risk_Profile_of_DAPT_Continuation_Beyond_1 Year_after_PCI_in_Patients_with_High_Thrombotic_Risk_Features_as_Endorsed_by_2018_ESC/EACTS_Myocardial_Revascularization_Guideline L2 - https://doi.org/10.1007/s10557-020-07030-9 DB - PRIME DP - Unbound Medicine ER -
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