دورية أكاديمية
Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis.
| العنوان: | Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis. |
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| المؤلفون: | Valgimigli M; Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH-6900 Lugano, Switzerland., Smits PC; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands., Frigoli E; CTU Bern, University of Bern, Bern, Switzerland., Bongiovanni D; Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH-6900 Lugano, Switzerland., Tijssen J; Amsterdam University Medical Center, Amsterdam, The Netherlands., Hovasse T; Ramsay Générale de Santé, ICPS, Hôpital Jacques Cartier, Massy, France., Mafragi A; Department of Cardiology, Zorgsaam Hospital, Terneuzen, The Netherlands., Ruifrok WT; Treant Zorggroep, Emmen, The Netherlands., Karageorgiev D; BAL Sveta Karidad, Plovdiv, Bulgaria., Aminian A; Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium., Garducci S; Unita' Operativa Complessa di Cardiologia, ASST Di Vimercate (MB), Vimercate, Italy., Merkely B; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Routledge H; Worcestershire Royal Hospital, Worcester, UK., Ando K; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan., Diaz Fernandez JF; Department of Cardiology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain., Cuisset T; Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France., Nesa Malik FT; National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh., Halabi M; Department of Cardiology, Ziv Medical Center, Safed, Israel., Belle L; Cardiology Department, Hospital of Annecy, Annecy, France., Din J; Royal Bournemouth Hospital, East Bournemouth, UK., Beygui F; Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France.; Électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie University, UNICAEN, Caen, France., Abhyankar A; Department of Cardiology, Shree B. D. Mehta Mahavir Heart Institute, Surat, India., Reczuch K; Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland., Pedrazzini G; Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH-6900 Lugano, Switzerland., Heg D; CTU Bern, University of Bern, Bern, Switzerland., Vranckx P; Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis Hasselt, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium. |
| مؤلفون مشاركون: | MASTER DAPT Investigators |
| المصدر: | European heart journal [Eur Heart J] 2022 Sep 01; Vol. 43 (33), pp. 3100-3114. |
| نوع المنشور: | Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 8006263 Publication Model: Print Cited Medium: Internet ISSN: 1522-9645 (Electronic) Linking ISSN: 0195668X NLM ISO Abbreviation: Eur Heart J Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2005- : Oxford : Oxford University Press Original Publication: London, Saunders [etc.] |
| مواضيع طبية MeSH: | Acute Coronary Syndrome*/drug therapy , Myocardial Infarction*/etiology , Percutaneous Coronary Intervention*/methods , Stroke*/epidemiology , Stroke*/etiology , Stroke*/prevention & control, Aspirin/adverse effects ; Drug Therapy, Combination ; Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Humans ; Platelet Aggregation Inhibitors/adverse effects ; Treatment Outcome |
| مستخلص: | Aim: To assess the effects of 1- or ≥3-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients who received biodegradable-polymer sirolimus-eluting stents for complex percutaneous coronary intervention (PCI) and/or acute coronary syndrome (ACS). Methods and Results: In the MASTER DAPT trial, 3383 patients underwent non-complex (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 complex (abbreviated DAPT, n = 588; standard DAPT, n = 608) PCI. Co-primary outcomes at 335 days were net adverse clinical events [NACE; composite of all-cause death, myocardial infarction, stroke, and bleeding academic research consortium (BARC) 3 or 5 bleeding events]; major adverse cardiac or cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and Types 2, 3, or 5 BARC bleeding. Net adverse clinical events and MACCE did not differ with abbreviated vs. standard DAPT among patients with complex [hazard ratio (HR): 1.03, 95% confidence interval (CI): 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively] and non-complex PCI (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; Pinteraction = 0.60 and 0.26, respectively). BARC 2, 3, or 5 was reduced with abbreviated DAPT in patients with and without complex PCI (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55-0.89; Pinteraction = 0.72). Among the 2816 patients with complex PCI and/or ACS, NACE and MACCE did not differ and BARC 2, 3, or 5 was lower with abbreviated DAPT. Conclusion: In HBR patients free from recurrent ischaemic events at 1 month, DAPT discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity. Clinical Trial Registration: This trial is registered with ClinicalTrials.gov, number NCT03023020, and is closed to new participants, with follow-up completed. Competing Interests: Conflict of interest: M.V. received an institutional grant from Terumo and consulting fees from Astra Zeneca, Terumo, Alvimedica/CID, Abbott Vascular, Daiichi Sankyo, Bayer, CoreFLOW, DORSIA Pharmaceuticals LTD, Vifor, Bristol Myers Squib SA, Biotronik, Boston scientific, Medtronic, Vesalio, Novartis, Chiesi, PhaseBio, ECRI. P.C.S. received institutional grants from Microport, SMT, Daichy Sankyo, and Abbott Vascular; consulting fees from Cavis and Abbott Vascular; honoraria from Abiomed, Terumo, and Abbott Vascular; participated on advisory board of Terumo, Abbott Vascular, and SMI. B.M. received grants from Medtronic and Boston Scientific; Speaker fee from Biotronik, Abbott, Astra Zeneca, Boehringer Ingelheim, and Novartis. T.C. received consulting fees from Medtronic, Abbott vascular, Terumo, and Boston Scientific; honoraria from Medtronic, Abbott vascular, Terumo, and Boston Scientific. F.T.N.M. received consulting fees from Terumo. K.R. received honoraria from Boston Scientific, Terumo, and Astra Zeneca. P.V. received consulting fees from Daiichi Sankyo, Novartis, CSL Behring, and Bayer AG; honoraria from Daiichi Sankyo and Servier; participated on advisory board for Daiichi Sankyo. All other authors declared no conflict of interest. (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) |
| التعليقات: | Comment in: Eur Heart J. 2022 Jul 21;:. (PMID: 35861271) Comment in: Ann Intern Med. 2022 Oct;175(10):JC112. (PMID: 36191320) |
| فهرسة مساهمة: | Keywords: Complex intervention; Dual antiplatelet therapy; High bleeding risk; Percutaneous coronary intervention |
| سلسلة جزيئية: | ClinicalTrials.gov NCT03023020 |
| المشرفين على المادة: | 0 (Platelet Aggregation Inhibitors) R16CO5Y76E (Aspirin) |
| تواريخ الأحداث: | Date Created: 20220517 Date Completed: 20220908 Latest Revision: 20221104 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1093/eurheartj/ehac284 |
| PMID: | 35580836 |
| قاعدة البيانات: | MEDLINE |
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