Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk

医学 心肌梗塞 内科学 急性冠脉综合征 心脏病学 不利影响 人口 经皮冠状动脉介入治疗 随机化 随机对照试验 环境卫生
作者
Pieter C. Smits,Enrico Frigoli,Pascal Vranckx,Yukio Ozaki,Marie‐Claude Morice,Bernard Chevalier,Yoshinobu Onuma,Stephan Windecker,Pim A.L. Tonino,Marco Roffi,Maciej Lesiak,Felix Mahfoud,Jozef Bartúnek,David Hildick‐Smith,Antonio Colombo,Goran Stanković,Andrés Íñiguez,Carl Schultz,Ran Kornowski,Paul Jau Lueng Ong,Mirvat Alasnag,Alfredo E. Rodríguez,Valeria Paradies,Petr Kala,Saško Kedev,Amar Al Mafragi,Willem Dewilde,Dik Heg,Marco Valgimigli
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:80 (13): 1220-1237 被引量:20
标识
DOI:10.1016/j.jacc.2022.07.016
摘要

The optimal duration of antiplatelet therapy (APT) after coronary stenting in patients at high bleeding risk (HBR) presenting with an acute coronary syndrome remains unclear.The objective of this study was to investigate the safety and efficacy of an abbreviated APT regimen after coronary stenting in an HBR population presenting with acute or recent myocardial infarction.In the MASTER DAPT trial, 4,579 patients at HBR were randomized after 1 month of dual APT (DAPT) to abbreviated (DAPT stopped and 11 months single APT or 5 months in patients with oral anticoagulants) or nonabbreviated APT (DAPT for minimum 3 months) strategies. Randomization was stratified by acute or recent myocardial infarction at index procedure. Coprimary outcomes at 335 days after randomization were net adverse clinical outcomes events (NACE); major adverse cardiac and cerebral events (MACCE); and type 2, 3, or 5 Bleeding Academic Research Consortium bleeding.NACE and MACCE did not differ with abbreviated vs nonabbreviated APT regimens in patients with an acute or recent myocardial infarction (n = 1,780; HR: 0.83; 95% CI: 0.61-1.12 and HR: 0.86; 95% CI: 0.62-1.19, respectively) or without an acute or recent myocardial infarction (n = 2,799; HR: 1.03; 95% CI: 0.77-1.38 and HR: 1.13; 95% CI: 0.80-1.59; Pinteraction = 0.31 and 0.25, respectively). Bleeding Academic Research Consortium 2, 3, or 5 bleeding was significantly reduced in patients with or without an acute or recent myocardial infarction (HR: 0.65; 95% CI: 0.46-0.91 and HR: 0.71; 95% CI: 0.54-0.92; Pinteraction = 0.72) with abbreviated APT.A 1-month DAPT strategy in patients with HBR presenting with an acute or recent myocardial infarction results in similar NACE and MACCE rates and reduces bleedings compared with a nonabbreviated DAPT strategy. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020).
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