RESUMO
BACKGROUND: This study aimed to evaluate real-world clinical outcome of patients needing short dual antiplatelet therapy (S-DAPT) following PCI with Ultimaster® thin-strut, biodegradable polymer sirolimus-eluting stent (BP-SES), which was supposed to induce faster stent endothelialization and reduce device thrombogenicity. METHODS: In this sub-group analysis of patients enrolled in the ULISSE registry, two groups were identified: 1) patients discharged with S-DAPT (≤3-month) due to high bleeding risk or need for urgent major non-cardiac surgery and 2) patients discharged with recommended DAPT (R-DAPT) duration (≥6-month). The primary ischemic-safety and bleeding-safety endpoints were TLF (composite of cardiac-death, target vessel MI, and clinically driven target lesion revascularization), and BARC major bleedings (≥type-3a) at 1-year follow-up. To account for events occurring before DAPT discontinuation we performed 3-month landmark analysis. RESULTS: 82 patients (5%) were discharged with ≤3-month DAPT (57⯱â¯27â¯days), and 1558 patients (94%) were discharged with ≥6-month DAPT (318⯱â¯75â¯days). No significant differences between S-DAPT and R-DAPT group were observed in TLF at 1-year (7.9% vs. 4.6%). The rate of BARC major bleeding resulted significantly higher in S-DAPT group (3.9% vs. 0.3%; pâ¯=â¯0.001), with the majority of bleeding events occurring within 3â¯months. The landmark analysis showed no significant differences in BARC major bleedings between groups (1.4% vs. 0.3%; pâ¯=â¯0.142). CONCLUSIONS: As compared to those treated with R-DAPT (≥6-month), patients needing -S-DAPT (≤3-month) after PCI with Ultimaster® BP-SES had similar rates of 1-year TLF and BARC major bleedings following early DAPT discontinuation.
Assuntos
Implantes Absorvíveis/tendências , Síndrome Coronariana Aguda/terapia , Stents Farmacológicos/tendências , Inibidores da Agregação Plaquetária/administração & dosagem , Sistema de Registros , Sirolimo/administração & dosagem , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Itália/epidemiologia , Pessoa de Meia-Idade , Polímeros , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoAssuntos
Capecitabina/efeitos adversos , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina/administração & dosagem , Cardiotoxicidade/diagnóstico , Cardiotoxicidade/etiologia , Cardiotoxicidade/prevenção & controle , Monitoramento de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Diagnóstico Precoce , HumanosAssuntos
Capecitabina , Reanimação Cardiopulmonar , Neoplasias Colorretais/tratamento farmacológico , Parada Cardíaca , Fibrilação Ventricular , Adulto , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina/administração & dosagem , Capecitabina/efeitos adversos , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Colectomia/métodos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Desfibriladores Implantáveis , Ecocardiografia/métodos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipertensão/complicações , Masculino , Resultado do Tratamento , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapiaRESUMO
Surgery is a common approach for diffuse coronary artery disease. Saphenous vein grafts are frequently used but are characterized by degeneration and high incidence of failure at 10 years. Percutaneous coronary intervention is preferred over re-operation because of age, comorbidity and the diffusion of coronary artery disease. With the saphenous vein graft occluded, percutaneous coronary intervention of native vessels and medical therapy alone are commonly suggested. We report three cases of patients with totally occluded saphenous vein grafts with suitable characteristics for treatment with Proxis, a device able to induce a proximal protection of the target vessel, minimizing the risk of distal embolization as well as the quantity of contrast required. In all patients there were no complications or cardiac enzyme elevations, and each case resulted in complete revascularization immediately postprocedure. Patients were asymptomatic at 6-month follow-up and procedural success was shown in two patients that consented to follow-up angiography. We conclude that Proxis could be a valuable tool for percutaneous coronary intervention of totally occluded saphenous vein grafts in patients who are poor candidates for percutaneous coronary intervention of native vessel; nevertheless these observations should be confirmed by a long-term follow-up controlled study.