TAT followed by DOAC monotherapy reduced the 5-year risk of clinically driven target lesion revascularization compared to DAPT in CCS patients (OR 0.367; 95% CI 0.147-0.917; p=0.032).
Cohort (n=1,046)
Does triple antithrombotic therapy followed by DOAC monotherapy reduce target lesion revascularization in patients with chronic coronary syndrome treated with a drug-eluting stent?
In patients with chronic coronary syndrome undergoing PCI, triple antithrombotic therapy followed by DOAC monotherapy was associated with a significantly lower 5-year risk of target lesion revascularization compared to DAPT, suggesting potential pleiotropic benefits of DOACs.
Effect estimate: OR 0.367 (95% CI 0.147-0.917)
Absolute Event Rate: 2.8% vs 8.4%
p-value: p=0.032
Abstract Background Percutaneous coronary intervention (PCI) is a widely used treatment strategy for coronary artery disease. A key challenge in long-term care post-PCI is the optimal antithrombotic regimen. Aim This substudy of the Vienna PCI Registry investigated the long-term effects of direct oral anticoagulant (DOAC) use on major adverse cardiac events (MACE) after PCI in patients with chronic coronary syndrome (CCS), exploring possible pleiotropic properties of DOACs. Methods We analyzed patients from the Vienna PCI Registry treated with a drug-eluting stent (DES) between January 1st, 2015, and December 31st, 2020. The primary endpoint was clinically driven target lesion revascularization (TLR). The secondary composite endpoint (MACE) included TLR, target vessel revascularization (TVR), stent thrombosis (ST), and all-cause death. Results A total of 1,046 CCS patients met inclusion criteria. Among them, 176 patients (16.8%) received triple antithrombotic therapy (TAT) followed by DOAC monotherapy. The primary endpoint TLR occurred significantly less often in TAT patients (2.8% vs 8.4%). MACE rates were similar between TAT and dual antiplatelet therapy (DAPT) patients (17.0% vs 17.0%). All-cause mortality was higher in the TAT group (11.9% vs 7.8%). Multivariable regression showed that TAT followed by DOAC monotherapy was associated with a reduced 5-year risk of TLR compared to patients on DAPT (OR 0.367, 95% CI: 0.147–0.917; p=0.032). Conclusion Patients with triple antiplatelet therapy (TAT) demonstrated a statistically significant risk decrease for the primary endpoint clinically driven TLR in the elective CCS PCI setting at 5-years follow-up, which may be in part due to pleiotropic effects of DOACs.Central IllustrationFor image description, please refer to the figure legend and surrounding text. Cumulative Incidence - TLRFor image description, please refer to the figure legend and surrounding text.
Christof Skos (2026) conducted a cohort in Chronic coronary syndrome (n=1,046). Triple antithrombotic therapy (TAT) followed by DOAC monotherapy vs. Dual antiplatelet therapy (DAPT) was evaluated on Clinically driven target lesion revascularization (TLR) (OR 0.367, 95% CI 0.147-0.917, p=0.032). TAT followed by DOAC monotherapy reduced the 5-year risk of clinically driven target lesion revascularization compared to DAPT in CCS patients (OR 0.367; 95% CI 0.147-0.917; p=0.032).