Davide Cao; Pascal Vranckx; Marco Valgimigli; Samantha Sartori; Dominick  J. Angiolillo; Sripal Bangalore; Deepak  L. Bhatt; Yihan Feng; Junbo Ge; James Hermiller; Raj  R. Makkar; Franz-Josef Neumann; Shigeru Saito; Hector Picon; Ralph Toelg; Aziz Maksoud; Bassem  M. Chehab; James  W. Choi; Gianluca Campo; José  M. De la Torre Hernandez; Mitchell  W. Krucoff; Vijay Kunadian; Gennaro Sardella; Alessandro Spirito; Holger Thiele; Olivier Varenne; Birgit Vogel; Yujie Zhou; Stephan Windecker; Roxana Mehran

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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