Key result
Bifurcation lesions carry similar cardiac death or MI risk as non-bifurcation lesions following 1-month DAPT.
Why the study?
Because bifurcation lesions carry a higher ischemic risk, it is unknown whether high bleeding risk patients undergoing PCI for bifurcation lesions can be safely treated with abbreviated 1-month DAPT.
Does 1-month DAPT after PCI with a zotarolimus-eluting stent yield comparable ischemic and bleeding outcomes in high bleeding risk patients with versus without bifurcation lesions?
Cohort (n=1,507)
Does 1-month DAPT after PCI with a zotarolimus-eluting stent yield comparable ischemic and bleeding outcomes in high bleeding risk patients with versus without bifurcation lesions?
Absolute Event Rate: 12.2% vs 11.6%
p-value: p=.92
In high bleeding risk patients undergoing PCI, 1-month DAPT after zotarolimus-eluting stent implantation yields similar 2-year ischemic and bleeding outcomes regardless of the presence of complex bifurcation lesions.
Short DAPT remains safe in high bleeding risk PCI patients with bifurcation lesions; extends evidence for abbreviated regimens in complex anatomy.
Background The optimal duration of dual antiplatelet therapy (DAPT) for high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) can vary based on individual clinical and lesion characteristics. As bifurcation lesions are associated with a greater risk of ischemic events, it is unknown whether HBR patients with bifurcation lesions can be safely treated with abbreviated DAPT. Methods We examined ischemic and bleeding outcomes in patients with and without bifurcation lesions who underwent PCI with the Resolute Onyx zotarolimus-eluting stent (Medtronic) from the Onyx ONE Clear study. HBR patients free of events through 1 month were prescribed 1 month of DAPT. Outcomes from 1 month to 2 years were analyzed among patients with HBR who underwent successful PCI for at least 1 bifurcation lesion followed by 1-month DAPT. Results Of 1507 total HBR patients, 215 (14.3%) underwent PCI of a bifurcation lesion, with 86.6% treated with a provisional approach. Included patients had an average of 1.6 HBR criteria. Patients with bifurcation lesions treated had more stents implanted and longer total length of stents implanted. The composite of cardiac death or myocardial infarction was similar for patients with vs without bifurcation lesions (12.2% vs 11.6%, P = .92). There were no differences in any clinical or angiographic outcomes between groups, including BARC 3 to 5 bleeding events. Conclusions In the Onyx ONE Clear study, HBR patients with bifurcation lesions treated with the Resolute Onyx zotarolimus-eluting stent and 1-month DAPT had comparable ischemic event rates at 2 years compared with patients without bifurcation lesions, despite greater lesion and procedural complexity.
No takes yet. Share an insight, caveat, or question.
Garnett et al. (2026) conducted a cohort in High bleeding risk patients undergoing percutaneous coronary intervention (n=1,507). PCI of a bifurcation lesion vs. PCI without bifurcation lesions was evaluated on Composite of cardiac death or myocardial infarction (p=.92). In high bleeding risk patients treated with 1-month DAPT after PCI, having a bifurcation lesion resulted in similar rates of cardiac death or myocardial infarction at 2 years compared to no bifurcation lesion (12.2% vs 11.6%, P=0.92).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: