Key result
Prolonged DAPT after bifurcation PCI linked to ~49% lower MACCE but higher major bleeding.
Why the study?
The optimal duration of DAPT following PCI of a bifurcation stenosis remains debated.
Does prolonged DAPT duration reduce MACCE in patients undergoing coronary bifurcation stenting?
Cohort (n=2,284)
Yes
Does prolonged DAPT duration reduce MACCE in patients undergoing coronary bifurcation stenting?
Hazard Ratio: 0.51 (95% CI 0.41–0.65)
Absolute Event Rate: 11.6% vs 21.5%
p-value: p=<0.001
In patients undergoing coronary bifurcation stenting, prolonged DAPT (>12 months) is associated with a significantly lower risk of MACCE but a potential increased risk of major bleeding compared to shorter durations.
Prolonged DAPT may lower MACCE after bifurcation stenting; leaves open causal effects, bleeding trade-offs, and need for RCTs.
BACKGROUND: Optimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) of a bifurcation stenosis is still debated. We evaluated the impact of DAPT duration on clinical outcomes in all-comers patients undergoing bifurcation PCI included in the European Bifurcation Club (EBC) registry. METHODS: We enrolled 2284 consecutive patients who completed at least 18 months follow-up. The cumulative occurrence of major adverse cardiac and cardiovascular events (MACCE), defined as a composite of overall-death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke were evaluated. Bleedings classified as Bleeding Academic Research Consortium (BARC) ≥3 were evaluated too. RESULTS: Patients were divided into 3 groups: short DAPT (<6-months, N.=375); standard DAPT (≥6-months but ≤12-months, N.=636); prolonged DAPT (>12-months, N.=1273). At 24 months follow-up MACCE-free survival was significantly lower in short DAPT patients (Log-Rank: 45.23, P for trend <0.001). MACCE occurred less frequently in the prolonged DAPT group (148 [11.6%]) as compared with both the short (83 [22.1%] HR: 0.48 [0.37-0.63], P<0.001) and standard DAPT groups (137 [21.5%] HR:0.51 [0.41-0.65], P<0.001). These differences remain after propensity score adjustment (respectively, HR: 0.27 [0.20-0.36] and HR: 0.44 [0.34-0.57]). Such finding was consistent in patients presenting with both acute and chronic coronary syndromes. BARC≥3 bleedings were 0.3% in the standard DAPT, 1.6% in short and 1.9% in prolonged DAPT groups. CONCLUSIONS: In the "real-world" EBC registry of patients undergoing PCI of coronary artery bifurcation stenosis, a prolonged DAPT duration was associated with a significantly lower risk of MACCE and a potential increased risk of major bleedings.
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Cirillo et al. (2022) conducted a cohort in Coronary bifurcation stenosis (n=2,284). Prolonged dual antiplatelet therapy (>12 months) vs. Standard DAPT (6-12 months) and short DAPT (<6 months) was evaluated on Major adverse cardiac and cardiovascular events (MACCE), defined as a composite of overall-death, non-fatal MI, TVR, and stroke (HR 0.51, 95% CI 0.41-0.65, p=<0.001). Prolonged DAPT (>12 months) after coronary bifurcation PCI was associated with lower MACCE risk (11.6% vs 21.5%; HR 0.51, P<0.001) but higher major bleeding (1.9% vs 0.3%) vs standard DAPT.
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