Original Research

DOI: 10.4244/EIJ-D-23-00658

One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes

Davide Cao1,2, MD; Pascal Vranckx3, MD; Marco Valgimigli4,5, MD, PhD; Samantha Sartori1, PhD; Dominick J. Angiolillo6, MD, PhD; Sripal Bangalore7, MD, MHA; Deepak L. Bhatt1, MD, MPH; Yihan Feng1, MS; Junbo Ge8, MD; James Hermiller9, MD; Raj R. Makkar10, MD; Franz-Josef Neumann11, MD, PhD; Shigeru Saito12, MD; Hector Picon13, MD; Ralph Toelg14, MD; Aziz Maksoud15, MD; Bassem M. Chehab16, MD; James W. Choi17, MD; Gianluca Campo18, MD; José M. De la Torre Hernandez19, MD, PhD; Mitchell W. Krucoff20, MD; Vijay Kunadian21, MD; Gennaro Sardella22, MD; Alessandro Spirito1, MD; Holger Thiele23, MD; Olivier Varenne24, MD; Birgit Vogel1, MD; Yujie Zhou25, MD; Stephan Windecker5, MD; Roxana Mehran1, MD

Abstract

BACKGROUND: A short dual antiplatelet therapy (DAPT) duration has been proposed for patients at high bleeding risk (HBR) undergoing drug-eluting coronary stent (DES) implantation. Whether this strategy is safe and effective after a non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains uncertain.

AIMS: We aimed to compare the impact of 1-month versus 3-month DAPT on clinical outcomes after DES implantation among HBR patients with or without NSTE-ACS.

METHODS: This is a prespecified analysis from the XIENCE Short DAPT programme involving three prospective, international, single-arm studies evaluating the safety and efficacy of 1-month (XIENCE 28 USA and Global) or 3-month (XIENCE 90) DAPT among HBR patients after implantation of a cobalt-chromium everolimus-eluting stent. Ischaemic and bleeding outcomes associated with 1- versus 3-month DAPT were assessed according to clinical presentation using propensity score stratification.

RESULTS: Of 3,364 HBR patients (1,392 on 1-month DAPT and 1,972 on 3-month DAPT), 1,164 (34.6%) underwent DES implantation for NSTE-ACS. At 12 months, the risk of the primary endpoint of death or myocardial infarction was similar between 1- and 3-month DAPT in patients with (hazard ratio [HR] 1.09, 95% confidence interval [CI]: 0.71-1.65) and without NSTE-ACS (HR 0.88, 95% CI: 0.63-1.23; p-interaction=0.34). The key secondary endpoint of Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding was consistently reduced in both NSTE-ACS (HR 0.57, 95% CI: 0.37-0.88) and stable patients (HR 0.84, 95% CI: 0.61-1.15; p-interaction=0.15) with 1-month DAPT.

CONCLUSIONS: Among HBR patients undergoing implantation of an everolimus-eluting stent, 1-month, compared to 3-month DAPT, was associated with similar ischaemic risk and reduced bleeding at 1 year, irrespective of clinical presentation.

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Volume 20 Number 10
May 20, 2024
Volume 20 Number 10
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