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Bernardete, Weber; Bersch, Ferreira  C; Torreglosa, Camila R; Marcadenti, Aline; Lara, Enilda S; Silva, Jaqueline T da; Costa, Rosana P; Santos, Renato H N; Berwanger, Otavio; Bosquetti, Rosa; Pagano, Raira; Mota, Luis G S; Oliveira, Juliana D de; Soares, Rafael M; Galante, Andrea P; Silva, Suzana A da; Zampieri, Fernando G; Kovacs, Cristiane; Amparo, Fernanda C; Moreira, Priscila; Silva, Renata A da; Santos, Karina G dos; Monteiro, Aline S5,; Paiva, Catharina C J; Magnoni, Carlos D; Moreira, Annie S; Peçanha, Daniela O; Missias, Karina C S; Paula, Lais S de; Marotto, Deborah; Souza, Paula; Martins, Patricia R T; Santos, Elisa M dos; Santos, Michelle R; Silva, Luisa P; Torres, Rosileide S; Barbosa, Socorro N A A; Pinho, Priscila M de; Araujo, Suzi H A de; Veríssimo, Adriana O L; Guterres, Aldair S; Cardoso, Andrea F R; Palmeira, Moacyr M; Ataíde, Bruno R B de; Costa, Lilian P S; Marinho, Helyde A; Araújo, Celme B P de; Carvalho, Helen M S; Maquiné, Rebecca O; Caiado, Alessandra C; Matos, Cristina H de; Barretta, Claiza; Specht, Clarice M; Onofrei, Mihaela; Bertacco, Renata T A; Borges, Lucia R; Bertoldi, Eduardo G; Longo, Aline; Ribas, Bruna L P; Dobke, Fernanda; Pretto, Alessandra D B; Bachettini, Nathalia P; Gastaud, Alexandre; Necchi, Rodrigo; Souza, Gabriela C; Zuchinali, Priccila; Fracasso, Bianca M; Bobadra, Sara; Sangali, Tamirys D; Salamoni, Joyce; Garlini, Luíza M; Shirmann, Gabriela S; Los Santos, Mônica L P de; Bortonili, Vera M S; Santos, Cristiano P dos; Bragança, Guilherme C M; Ambrózio, Cíntia L; Lima, Susi B E; Schiavini, Jéssica; Napparo, Alechandra S; Boemo, Jorge L; Nagano, Francisca E Z; Modanese, Paulo V G; Cunha, Natalia M; Frehner, Caroline; Silva, Lannay F da; Formentini, Franciane S; Ramos, Maria E M; Ramos, Salvador S; Lucas, Marilia C S; Machado, Bruna G; Ruschel, Karen B; Beiersdorf, Jâneffer R; Nunes, Cristine E; Rech, Rafael L; Damiani, Mônica; Berbigier, Marina; Poloni, Soraia; Vian, Izabele; Russo, Diana S; Rodrigues, Juliane; Moraes, Maria A P de; Costa, Laura M da; Boklis, Mirena; El Kik, Raquel M; Adorne, Elaine F; Teixeira, Joise M; Trescastro, Eduardo P; Chiesa, Fernanda L; Telles, Cristina T; Pellegrini, Livia A; Reis, Lucas F; Cardoso, Roberta G M; Closs, Vera E; Feres, Noel H; Silva, Nilma F da; Silva, Neyla E; Dutra, Eliane S; Ito, Marina K; Lima, Mariana E P; Carvalho, Ana P P F; Taboada, Maria I S; Machado, Malaine M A; David, Marta M; Júnior, Délcio G S; Dourado, Camila; Fagundes, Vanessa C F O; Uehara, Rose M; Sasso, Sandramara; Vieira, Jaqueline S O; Oliveira, Bianca A S de; Pereira, Juliana L; Rodrigues, Isa G; Pinho, Claudia P S; Sousa, Antonio C S; Almeida, Andreza S; Jesus, Monique T de; Silva, Glauber B da; Alves, Lucicna V S; Nascimento, Viviane O G; Vieira, Sabrina A; Coura, Amanda G L; Dantas, Clenise F; Leda, Neuma M F S; Medeiros, Auriene L; Andrade, Ana C L; Pinheiro, Josilene M F; Lima, Luana R M de; Sabino, L S; Souza, C V S de; Vasconcelos, S M L; Costa, F A; Ferreira, R C; Cardoso, I B; Navarro, L N P; Ferreira, R B; Júnior, A E S; Silva, M B G; Almeida, K M M; Penafort, A M; Queirós, A P O de; Farias, G M N; Carlos, D M O; Cordeiro, C G N C; Vasconcelos, V B; Araújo, E M V M C de; Sahade, V; Ribeiro, C S A; Araujo, G A; Gonçalves, L B; Teixeira, C S; Silva, L M A J; Costa, L B de; Souza, T S; Jesus, S O de; Luna, A B; Rocha, B R S da; Santos, M A; Neto, J A F; Dias, L P P; Cantanhede, R C A; Morais, J M; Duarte, R C L; Barbosa, E C B; Barbosa, J M A; Sousa, R M L de; Santos, A F dos; Teixeira, A F; Moriguchi, E H; Bruscato, N M; Kesties, J; Vivian, L; Carli, W de; Shumacher, M; Izar, M C O; Asoo, M T; Kato, J T; Martins, C M; Machado, V A; Bittencourt, C R O; Freitas, T T de; Sant'Anna, V A R; Lopes, J D; Fischer, S C P M; Pinto, S L; Silva, K C; Gratão, L H A; Holzbach, L C; Backes, L M; Rodrigues, M P; Deucher, K L A L; Cantarelli, M; Bertoni, V M; Rampazzo, D; Bressan, J; Hermsdorff, H H M; Caldas, A P S; Felício, M B; Honório, C R; Silva, A da; Souza, S R; Rodrigues, P A; Meneses, T M X de; Kumbier, M C C; Barreto, A L; Cavalcanti, A B.
Am. heart j ; 215: 187-197, Set. 2019. graf, tab
Article in English | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1023356

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)


Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Nutrition Assessment , Diet, Food, and Nutrition
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