Abstract：
BACKGROUND: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention.
RESULTS: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88-1.11], P=0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94-1.25]), or their components between groups. The results were consistent among all of the investigated subgroups.
CONCLUSIONS: In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.
RESULTS: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88-1.11], P=0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94-1.25]), or their components between groups. The results were consistent among all of the investigated subgroups.
CONCLUSIONS: In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.
摘要：
背景：双重抗血小板治疗（DAPT）可减少缺血事件，但增加出血风险，尤其是高出血风险（HBR）患者。这项研究旨在比较缩写与标准DAPT策略在接受经皮冠状动脉介入治疗的急性冠脉综合征HBR患者中的结果。
结果：来自SWEDEHEART（根据推荐的治疗方法评估的基于证据的心脏疾病裸眼增强和发展的瑞典网络系统）注册表的患者至少有1项HBR标准，并接受了经皮冠状动脉介入治疗急性冠状动脉综合征。根据出院时计划的DAPT时间将患者分为2组：12个月的DAPT或缩写的DAPT策略，并根据出院时的处方P2Y12抑制剂进行匹配。评估的主要结果是1年净不良临床事件发生时间，包括心脏死亡，心肌梗塞,缺血性卒中,或临床上明显的出血。至主要不良心血管事件的时间和净不良临床事件的各个组成部分被认为是次要终点。每组共纳入4583例患者。最常符合HBR标准的是年龄大于75岁（65.6％），并且在标准DAPT组和口服抗凝治疗（79.6％）中接受支架植入和随后的双重抗血小板治疗的患者中预测出血并发症（44.6％）和年龄75岁及以上（55.2％）在缩写的DAPT组中。净不良临床事件无统计学差异（12.9%对13.1%；风险比[HR]，0.99[95%CI，0.88-1.11]，P=0.83),主要不良心血管事件（8.6%对7.9%；HR，1.08[95%CI，0.94-1.25])，或它们之间的组件。所有调查的亚组的结果是一致的。
结论：在因急性冠状动脉综合征而接受经皮冠状动脉介入治疗的HBR患者中，缩写的DAPT与12个月的DAPT持续时间的净不良临床事件和主要不良心血管事件的发生率相当。
结果：来自SWEDEHEART（根据推荐的治疗方法评估的基于证据的心脏疾病裸眼增强和发展的瑞典网络系统）注册表的患者至少有1项HBR标准，并接受了经皮冠状动脉介入治疗急性冠状动脉综合征。根据出院时计划的DAPT时间将患者分为2组：12个月的DAPT或缩写的DAPT策略，并根据出院时的处方P2Y12抑制剂进行匹配。评估的主要结果是1年净不良临床事件发生时间，包括心脏死亡，心肌梗塞,缺血性卒中,或临床上明显的出血。至主要不良心血管事件的时间和净不良临床事件的各个组成部分被认为是次要终点。每组共纳入4583例患者。最常符合HBR标准的是年龄大于75岁（65.6％），并且在标准DAPT组和口服抗凝治疗（79.6％）中接受支架植入和随后的双重抗血小板治疗的患者中预测出血并发症（44.6％）和年龄75岁及以上（55.2％）在缩写的DAPT组中。净不良临床事件无统计学差异（12.9%对13.1%；风险比[HR]，0.99[95%CI，0.88-1.11]，P=0.83),主要不良心血管事件（8.6%对7.9%；HR，1.08[95%CI，0.94-1.25])，或它们之间的组件。所有调查的亚组的结果是一致的。
结论：在因急性冠状动脉综合征而接受经皮冠状动脉介入治疗的HBR患者中，缩写的DAPT与12个月的DAPT持续时间的净不良临床事件和主要不良心血管事件的发生率相当。
