1- Versus 3-Month DAPT in Older Patients at a High Bleeding Risk Undergoing PCI: Insights from the XIENCE Short DAPT Global Program.

Abstract

This analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from 3 prospective, single-arm studies (XIENCE Short DAPT Program), including patients with high bleeding risk successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and <75 years). The primary end point was all-cause death or myocardial infarction (MI). The key secondary end point was Bleeding Academic Research Consortium type 2 to 5 bleeding. The outcomes were assessed from 1 to 12 months after index PCI. Of 3,364 patients, 2,241 (66.6%) were aged ≥75 years. The risk of death or MI was similar with 1- versus 3-month DAPT in patients aged ≥75 (8.5% vs 8.0%, adjusted hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.69 to 1.30) and <75 years (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60 to 1.57, interaction p = 0.478). Bleeding Academic Research Consortium type 2 to 5 bleeding was consistently lower with 1- than with 3-month DAPT in patients aged ≥75 years (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48 to 0.91) and <75 years (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57 to 1.29, interaction p = 0.737). In conclusion, in patients at high bleeding risk who underwent PCI, patients older and younger than 75 years derived a consistent benefit from 1- compared with 3-month DAPT in terms of bleeding reduction, with no increase in all-cause death or MI at 1 year.

• Authors: Gennaro Sardella, Alessandro Spirito, Samantha Sartori, Dominick J Angiolillo, Pascal Vranckx, Jose M De la Torre Hernandez, Mitchell W Krucoff, Sripal Bangalore, Deepak L Bhatt, Gianluca Campo, Davide Cao, Bassem M Chehab, James W Choi, Yihan Feng, Junbo Ge, Katherine Godfrey, James Hermiller, Vijay Kunadian, Raj R Makkar, Aziz Maksoud, Franz-Josef Neumann, Hector Picon, Shigeru Saito, Holger Thiele, Ralph Toelg, Olivier Varenne, Birgit Vogel, Yujie Zhou, Marco Valgimigli, Stephan Windecker, Roxana Mehran
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 214 Pg. 94-104 (Mar 01 2024) ISSN: 1879-1913 [Electronic] United States
• PMID: 38185438 (Publication Type: Journal Article)
• Copyright: Copyright © 2024 Elsevier Inc. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Humans
• Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Drug-Eluting Stents
• Percutaneous Coronary Intervention (adverse effects)
• Prospective Studies
• Drug Therapy, Combination
• Hemorrhage (epidemiology, chemically induced)
• Myocardial Infarction (epidemiology, drug therapy)
• Treatment Outcome