Dual antiplatelet therapy duration based on ischemic and bleeding risks after coronary stenting
J. Am. Coll. Cardiol
; 73(7): 741-754, Fev. 2019. gráfico, tabela, ilustração
Article
em En
| SES-SP, CONASS, SESSP-IDPCPROD, SES-SP
| ID: biblio-1023289
Biblioteca responsável:
BR79.1
Localização: BR79.1
ABSTRACT
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference −3.86%; 95% confidence interval −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference −1.14%; 95% confidence interval −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)
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Bases de dados:
CONASS
/
SES-SP
Assunto principal:
Inibidores da Agregação Plaquetária
/
Stents
/
Doença das Coronárias
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J. Am. Coll. Cardiol
Ano de publicação:
2019
Tipo de documento:
Article