Alongside other established clinical risk factors, procedural complexity is an important parameter to take into account in tailoring upfront duration of dual antiplatelet therapy (DAPT) following complex percutaneous coronary intervention (PCI) with drug-eluting stents, according to a study presented Aug. 29 during ESC Congress 2016 in Rome and simultaneously published in the Journal of the American College of Cardiology.

The study, by Gennaro Giustino, MD, et al., pooled data for 9,577 patients from six randomized controlled trials, investigated the efficacy and safety of long-term (12 months) vs. short-term (three or six months) DAPT with aspirin and clopidogrel according to PCI complexity. The primary efficacy endpoint was major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. The primary safety endpoint was major bleeding. Intention-to-treat was the primary analytic approach.

Results showed 1,680 patients (17.5 percent) underwent complex PCI and had a higher risk of MACE at the median follow-up time of 392 days compared to the non-complex group. Those patients in the complex PCI group saw significant reductions in MACE with long-term DAPT compared with short-term DAPT. Researchers noted the magnitude of the benefit with long-term DAPT was progressively greater per increase in procedural complexity. However, long-term DAPT was associated with increased risk for major bleeding, irrespective of procedural complexity.

Moving forward, study authors note that “patients who undergo complex PCI might benefit from upfront longer (>6 months) DAPT duration to prevent MACE, irrespective of clinical presentation.” Additionally, “ad hoc pharmacological strategies to optimize outcomes after complex PCI may warrant prospective randomized investigation.”

Keywords: ESC Congress, Aspirin, Drug-Eluting Stents, Hemorrhage, Intention to Treat Analysis, Myocardial Infarction, Percutaneous Coronary Intervention, Prospective Studies, Randomized Controlled Trials as Topic, Research Personnel, Risk Factors, Thrombosis, Ticlopidine

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