Angelo Oliva; Dominick Angiolillo; Marco Valgimigli; Davide Cao; Samantha Sartori; Sripal Bangalore; Deepak Bhatt; Gianluca Campo; Bassem Chehab; James Choi; Jose de la Torre Hernandez; Yihan Feng; Junbo Ge; Mauro Gitto; James Hermiller; Mitchell Krucoff; Vijay Kunadian; Raj Makkar; Aziz Maksoud; Franz-Josef Neumann; Hector Picon; Shigeru Saito; Gennaro Sardella; Holger Thiele; Ralph Toelg; Olivier Varenne; Birgit Vogel; Pascal Vranckx; Stephan Windecker; Roxana Mehran

doi:10.4244/EIJ-D-24-00897

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Original Research

DOI: 10.4244/EIJ-D-24-00897

One- versus three-month DAPT after everolimus-eluting stent implantation in diabetic patients at high bleeding risk: results from the XIENCE Short DAPT programme

Angelo Oliva¹^,², MD; Dominick J. Angiolillo³, MD, PhD; Marco Valgimigli⁴^,⁵, MD, PhD; Davide Cao¹^,², MD; Samantha Sartori¹, PhD; Sripal Bangalore⁶, MD, MHA; Deepak L. Bhatt¹, MD, MPH, MBA; Gianluca Campo⁷, MD; Bassem M. Chehab⁸, MD; James W. Choi⁹^,¹⁰, MD; Jose M. de la Torre Hernandez¹¹, MD, PhD; Yihan Feng¹, MS; Junbo Ge¹², MD; Mauro Gitto¹^,², MD; James Hermiller¹³, MD; Mitchell W. Krucoff¹⁴, MD; Vijay Kunadian¹⁵, MD; Raj R. Makkar¹⁶, MD; Aziz Maksoud¹⁷, MD; Franz-Josef Neumann¹⁸, MD; Hector Picon¹⁹, MD; Shigeru Saito²⁰, MD; Gennaro Sardella²¹, MD; Holger Thiele²², MD; Ralph Toelg²³^,²⁴, MD; Olivier Varenne²⁵, MD, PhD; Birgit Vogel¹, MD; Pascal Vranckx²⁶, MD; Stephan Windecker²⁷, MD; Roxana Mehran¹, MD

1. Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; 3. Division of Cardiology, Department of Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL, USA; 4. Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano (EOC), Università della Svizzera Italiana (USI), Lugano, Switzerland; 5. Bern University Hospital, Bern, Switzerland; 6. Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA; 7. Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; 8. Ascension Via Christi Hospital, Cardiovascular Research Institute of Kansas, Wichita, KS, USA; 9. Texas Health Presbyterian Hospital, Dallas, TX, USA; 10. Baylor Scott and White Research Institute, Dallas, TX, USA; 11. Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain; 12. Zhongshan Hospital Fudan University, Shanghai, China; 13. St Vincent Heart Center of Indiana, Indianapolis, IN, USA; 14. Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA; 15. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; 16. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 17. Kansas Heart Hospital, Wichita, KS, USA and University of Kansas School of Medicine, Wichita, KS, USA; 18. Department of Cardiology and Angiology, University Heart Centre Freiburg Medical Centre - University of Freiburg, Bad Krozingen, Germany; 19. Redmond Regional Medical Center, Rome, GA, USA; 20. Shonan Kamakura General Hospital, Kamakura, Japan; 21. Policlinico Umberto I di Roma, Rome, Italy; 22. Heart Center Leipzig at University of Leipzig, Leipzig, Germany and Leipzig Heart Science, Leipzig, Germany; 23. Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe Germany; 24. Medical Faculty of the Christian-Albrechts-University of Kiel, Kiel, Germany; 25. Hôpital Cochin, APHP, Université de Paris Cité, Paris, France; 26. Department of Cardiology and Critical Care Medicine, Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, University of Hasselt, Hasselt, Belgium; 27. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland

Abstract

Background: In patients with diabetes mellitus (DM) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI), the optimal duration of dual antiplatelet therapy (DAPT) remains uncertain.

Aims: We sought to compare early DAPT discontinuation in DM and non-DM patients enrolled in the prospective XIENCE Short DAPT programme.

Methods: The effects of 1- versus 3-month DAPT on ischaemic and bleeding outcomes were compared using propensity score stratification. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 1 year. The incidence of Bleeding Academic Research Consortium (BARC) Type 2 to 5 bleeding was the key secondary endpoint.

Results: Out of 3,352 included patients, 1,299 (38.8%) had DM; diabetic patients had a higher 1-year incidence of death or MI (DM vs non-DM: 10.1% vs 6.6%) and similar BARC 2-5 bleeding (DM vs non-DM: 9.5% vs 9.2%). With 1- versus 3-month DAPT, the incidence of death or MI did not statistically differ in DM patients (adjusted hazard ratio [adjHR] 0.70, 95% confidence interval [CI]: 0.47-1.05) and non-DM patients (adjHR 1.26, 95% CI: 0.87-1.81), although heterogeneity by DM status was evident (p for interaction=0.015). BARC 2-5 bleeding was numerically lower with 1-month DAPT in both groups (DM: adjHR 0.67, 95% CI: 0.45-1.01; non-DM: adjHR 0.78, 95% CI: 0.56-1.07; p for interaction=0.973).

Conclusions: Among HBR patients with DM undergoing PCI, 1-month DAPT, as compared to 3-month DAPT, was not associated with an excess of fatal or non-fatal MI and even reduced the occurrence of bleeding. These findings should be interpreted in the context of a predominantly stable patient population with low procedural complexity and may not be generalisable to higher-risk cases.

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percutaneous coronary intervention diabetes bleeding DAPT high bleeding risk

Volume 21 Number 12

Jun 16, 2025