ABSTRACT
Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is the cornerstone of post-percutaneous coronary intervention treatment to prevent stent thrombosis and reduce the risk of adverse cardiovascular events. The selection of an optimal DAPT regimen, considering the interplay of various antiplatelet agents, patient profiles, and procedural characteristics, remains an evolving challenge. Traditionally, a standard duration of 12 months has been recommended for DAPT in most patients. While contemporary guidelines provide general frameworks, DAPT modulation with longer or shorter treatment courses followed by aspirin or P2Y12 inhibitor monotherapy are evolving towards an individualized strategy to optimize the balance between efficacy and safety. This review comprehensively examines the current landscape of DAPT strategies after coronary stenting, with a focus on emerging evidence for treatment individualization.
ABSTRACT
BACKGROUND: FFR-guided coronary intervention is recommended for patients with intermediate stenoses. However, concerns exist with this approach in anatomically prognostic disease. METHODS: In this prospective, multicentre study, we consecutively enrolled patients found to have FFR negative lesions in anatomically significant sites: left main; proximal LAD; last remaining patent vessel; and multiple vessels with concomitant impaired left ventricular systolic function (EFâ¯<â¯40%). As per recommendation, revascularisation was deferred, and patients included into a registry. The primary endpoint was MACE (death, myocardial infarction and unplanned target lesion revascularization). Secondary endpoints were the above individual components. Subgroup analyses were performed for clinical presentation (stable vs. ACS), localization of lesion (ostial vs. non ostial) and renal function. RESULTS: The registry included 292 patients with 297 deferred stenoses. After 1-year, the primary endpoint occurred in 5% of patients, mainly driven by TLR (2.7%). Cardiovascular death occurred in 0.8% and AMI in 0.8%. During a follow-up of 22.2⯱â¯11â¯months, MACE occurred in 11.6%. Cardiovascular death occurred in 1.8% and AMI in 2.1%. After multivariate analysis, impaired renal function (OR 1.99; CI 95% 1.74-5.41; pâ¯=â¯0.046) and ostial disease (OR 2.88; CI 95% 1.04-7.38; pâ¯=â¯0.041) were found to be predictors of MACE. Impaired renal function also predicted TLR (OR 2.43; CI 95% 1.17-5.02; pâ¯=â¯0.017). CONCLUSION: FFR-guided revascularisation deferral is safe in the majority of anatomically prognostic disease. However, further evaluation is required in the risk stratification of those patients with ostial disease and renal disease. Registered on ClinicalTrials, NCT02590926.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Fractional Flow Reserve, Myocardial/physiology , Myocardial Revascularization/methods , Aged , Coronary Artery Disease/mortality , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Revascularization/adverse effects , Myocardial Revascularization/mortality , Prognosis , Prospective Studies , Registries , Survival Rate/trendsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Refractory Period, Electrophysiological/physiology , Bundle-Branch Block/diagnostic imaging , Bundle of His/diagnostic imaging , Lown-Ganong-Levine Syndrome/complications , Lown-Ganong-Levine Syndrome/diagnostic imaging , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/trendsABSTRACT
No disponible
