未经证实:高出血风险(HBR)和复杂的经皮冠状动脉介入治疗(PCI)是双重抗血小板治疗(DAPT)持续时间的主要决定因素。
未经评估:本研究的目的是评估HBR和复杂PCI对短期与标准DAPT的影响。
UNASSIGNED:在STOPDAPT-2(Verulam's洗脱钴铬支架-2后双重抗血小板治疗的短期和最佳持续时间)总队列中,根据学术研究联盟定义的HBR和复杂PCI进行了亚组分析,将1个月DAPT后的氯吡格雷单药治疗与PCI后的12个月DAPT联合阿司匹林和氯吡格雷进行随机比较。主要终点是心血管疾病(心血管死亡,心肌梗塞,明确的支架血栓形成,或中风)或出血(心肌梗死溶栓[TIMI]主要或次要)1年终点。
未经评估:无论HBR(n=1,893[31.6%])和复杂PCI(n=999[16.7%]),1个月DAPT相对于12个月DAPT的风险对于主要终点(HBR,5.01%对5.14%;非HBR,1.90%vs2.02%;P交互作用=0.95)(复杂PCI,3.15%vs4.07%;非复杂PCI,2.78%vs2.82%;P交互作用=0.48)和心血管终点(HBR,4.35%对3.52%;非HBR,1.56%vs1.22%;P交互作用=0.90)(复杂PCI,2.53%vs2.52%;非复杂PCI,2.38%vs1.86%;P交互作用=0.53),而出血终点较低(HBR,0.66%对2.27%;非HBR,0.43%vs0.85%;P交互作用=0.36)(复杂PCI,0.63%vs1.75%;非复杂PCI,0.48%vs1.22%;P交互作用=0.90)。有HBR的患者在1个月和12个月DAPT之间的出血绝对差异在数字上大于无HBR的患者(-1.61%vs-0.42%)。
未经评估:1个月DAPT相对于12个月DAPT的影响是一致的,无论HBR和复杂PCI。1个月DAPT比12个月DAPT在减少大出血方面的绝对益处在HBR患者中的数值上大于无HBR患者。复杂PCI可能不是PCI后DAPT持续时间的适当决定因素。(依维莫司洗脱钴铬支架-2[STOPDAPT-2]后双重抗血小板治疗的短期和最佳持续时间,NCT02619760;ACS患者在依维莫司洗脱钴铬支架-2后双重抗血小板治疗的短和最佳持续时间[STOPDAPT-2ACS],NCT03462498)。
UNASSIGNED: High bleeding risk (HBR) and complex percutaneous coronary intervention (PCI) are major determinants for dual antiplatelet therapy (DAPT) duration.
UNASSIGNED: The aim of this study was to evaluate the effects of HBR and complex PCI on short vs standard DAPT.
UNASSIGNED: Subgroup analyses were conducted on the basis of Academic Research Consortium-defined HBR and complex PCI in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Verulam\'s-Eluting Cobalt-Chromium Stent-2) Total Cohort, which randomly compared clopidogrel monotherapy after 1-month DAPT with 12-month DAPT with aspirin and clopidogrel after PCI. The primary endpoint was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (Thrombolysis In Myocardial Infarction [TIMI] major or minor) endpoints at 1 year.
UNASSIGNED: Regardless of HBR (n = 1,893 [31.6%]) and complex PCI (n = 999 [16.7%]), the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (HBR, 5.01% vs 5.14%; non-HBR, 1.90% vs 2.02%; P interaction = 0.95) (complex PCI, 3.15% vs 4.07%; noncomplex PCI, 2.78% vs 2.82%; P interaction = 0.48) and for the cardiovascular endpoint (HBR, 4.35% vs 3.52%; and non-HBR, 1.56% vs 1.22%; P interaction = 0.90) (complex PCI, 2.53% vs 2.52%; noncomplex PCI, 2.38% vs 1.86%; P interaction = 0.53), while it was lower for the bleeding endpoint (HBR, 0.66% vs 2.27%; non-HBR, 0.43% vs 0.85%; P interaction = 0.36) (complex PCI, 0.63% vs 1.75%; noncomplex PCI, 0.48% vs 1.22%; P interaction = 0.90). The absolute difference in the bleeding between 1- and 12-month DAPT was numerically greater in patients with HBR than in those without HBR (-1.61% vs -0.42%).
UNASSIGNED: The effects of 1-month DAPT relative to 12-month DAPT were consistent regardless of HBR and complex PCI. The absolute benefit of 1-month DAPT over 12-month DAPT in reducing major bleeding was numerically greater in patients with HBR than in those without HBR. Complex PCI might not be an appropriate determinant for DAPT durations after PCI. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498).