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.

Impact of dual antiplatelet therapy duration on clinical outcome after coronary bifurcation stenting: results from the EuroBifurcation Club registry / Cirillo, Plinio; DI Serafino, Luigi; Gamra, Habib; Zimarino, Marco; Barbato, Emanuele; Briguori, Carlo; Amat-Santos, Ignatio J; Chieffo, Alaide; Erglis, Andrejs; Gil, Robert J; Kedev, Sasko A; Petrov, Ivo; Radico, Francesco; Niglio, Tullio; Nakamura, Sunao; Costa, Ricardo A; Kanic, Vojko; Perfetti, Matteo; Pellicano, Mariano; Maric, Kristina; Tesorio, Tullio; Vukcevic, Vladan; Esposito, Giovanni; Stankovic, Goran. - In: PANMINERVA MEDICA. - ISSN 1827-1898. - 65:1(2023), pp. 1-12. [10.23736/S0031-0808.22.04604-3]

Impact of dual antiplatelet therapy duration on clinical outcome after coronary bifurcation stenting: results from the EuroBifurcation Club registry

Cirillo, Plinio;DI Serafino, Luigi;Barbato, Emanuele;Esposito, Giovanni;
2023

Abstract

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.
2023
Impact of dual antiplatelet therapy duration on clinical outcome after coronary bifurcation stenting: results from the EuroBifurcation Club registry / Cirillo, Plinio; DI Serafino, Luigi; Gamra, Habib; Zimarino, Marco; Barbato, Emanuele; Briguori, Carlo; Amat-Santos, Ignatio J; Chieffo, Alaide; Erglis, Andrejs; Gil, Robert J; Kedev, Sasko A; Petrov, Ivo; Radico, Francesco; Niglio, Tullio; Nakamura, Sunao; Costa, Ricardo A; Kanic, Vojko; Perfetti, Matteo; Pellicano, Mariano; Maric, Kristina; Tesorio, Tullio; Vukcevic, Vladan; Esposito, Giovanni; Stankovic, Goran. - In: PANMINERVA MEDICA. - ISSN 1827-1898. - 65:1(2023), pp. 1-12. [10.23736/S0031-0808.22.04604-3]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/915672
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