Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014-2019).

Background: while the duration of dual antiplatelet therapy (DAPT) following coronary angioplasty for chronic coronary syndrome (CCS) recommended by the European Society of Cardiology has decreased over the last decade, little is known about the adherence to those guidelines in clinical practice in France. Aim: To analyze the real duration of DAPT post coronary angioplasty in CCS, as well as the factors affecting this duration. Methods: Between 2014 and 2019, 8.836 percutaneous coronary interventions for CCS from the France-PCI registry were evaluated, with 1 year follow up, after exclusion of patients receiving oral anticoagulants, procedures performed within one year of an acute coronary syndrome, and repeat angioplasty. Results: Post-percutaneous coronary intervention (PCI) DAPT duration was > 12 months for 53.1% of patients treated for CCS; 30.5% had a DAPT between 7 and 12 months, and 16.4% a DAPT ≤ 6 months. Patients with L-DAPT (>12 months) were at higher ischemic risk [25.0% of DAPT score ≥2 vs. 18.8% DAPT score ≥2 in S&I-DAPT group (≤12 months)]. The most commonly used P2Y12 inhibitor was clopidogrel (82.2%). The prescription of ticagrelor increased over the period. Conclusions: post-PCI DAPT duration in CCS was higher than international recommendations in the France PCI registry between 2014 and 2019. More than half of the angioplasty performed for CCS are followed by a DAPT > 12 months. Ischemic risk assessment influences the duration of DAPT. This risk is probably overestimated nowadays, leading to a prolongation of DAPT beyond the recommended durations, thus increasing the bleeding risk.

[Percutaneous treatment of chronic total coronary occlusion]. / Le traitement percutané des occlusions coronaires chroniques.

Although frequent, chronic total occlusion (CTO) has long been neglected by interventional cardiologists, considering that the risk of complications was too high compared to the expected benefits. The presence of a CTO has therefore been an essential decision-making factor for referral of patients with multivessel disease to surgical coronary revascularization, or for the choice of the optimization of medical treatment in patients with an isolated CTO. The recent years technical progress of and the development of specific tools for percutaneous treatment of CTO have allowed to gradually change the vision within the cardiology community as the benefits in terms of quality of life and of complete revascularization have been clearly demonstrated. In contrast, the benefit on survival and improvement of left ventricular systolic function, although highlighted in meta-analyses and in some registries, has yet to be demonstrated by prospective randomized studies. The different reasons for considering percutaneous revascularization of CTO are discussed in this article. We will also review how to select patients based on clinical and angiographic data.

Bien que fréquentes, les occlusions coronaires chroniques («chronic total occlusion¼, CTO) ont longtemps été négligées par les cardiologues interventionnels, considérant que le risque de complications lié à une tentative de revascularisation était trop élevé par rapport aux bénéfices escomptés. La présence d'une CTO a, dès lors, été un facteur décisionnel essentiel pour l'orientation des patients vers une chirurgie de revascularisation coronarienne en cas d'atteinte pluritronculaire, ou pour le choix de l'optimalisation du traitement médical chez les patients avec une CTO isolée. Les progrès techniques de ces dernières années et le développement d'un matériel spécifique pour le traitement percutané des CTO ont permis de progressivement modifier la vision au sein de la communauté des cardiologues interventionnels, d'autant que les bénéfices en ce qui concerne la qualité de vie et les possibilités de revascularisation complète ont été clairement démontrés. En revanche, les bénéfices sur la survie et l'amélioration de la fonction systolique ventriculaire gauche, bien que démontrés dans les méta-analyses et certains registres, doivent encore être confirmés par des études prospectives randomisées. Les différentes raisons d'envisager une revascularisation percutanée des CTO sont discutées dans cet article. Nous ferons également le point quant à la manière de sélectionner les patients sur base des données cliniques et angiographiques. Mots-clés : Occlusion coronaire chronique - Qualité de vie - Angioplastie coronaire percutanée.