在 PCI 后有或无口服抗凝治疗的 HBR 患者中应用 1-或 3 个月 DAPT。
1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI.
机构信息
Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland.
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
JACC Cardiovasc Interv. 2023 Oct 23;16(20):2498-2510. doi: 10.1016/j.jcin.2023.08.014. Epub 2023 Oct 4.
BACKGROUND
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain.
OBJECTIVES
The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program.
METHODS
The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI.
RESULTS
Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS).
CONCLUSIONS
Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment.
背景
在长期接受口服抗凝治疗（OAC）的经皮冠状动脉介入治疗（PCI）患者中，双联抗血小板治疗（DAPT）的最佳持续时间仍不确定。
目的
本分析旨在评估 XIENCE 短期 DAPT 研究中接受 OAC 治疗的患者与未接受 OAC 治疗的患者中，1 个月与 3 个月 DAPT 的效果。
方法
XIENCE 短期 DAPT 研究纳入了高出血风险且接受钴铬依维莫司洗脱支架成功 PCI 的患者。无缺血事件且治疗依从性好的患者在 1 个月或 3 个月时停用 DAPT。采用倾向评分分层比较 1 个月与 3 个月 DAPT 的效果。主要终点是全因死亡或任何心肌梗死（MI）。关键次要终点是 Bleeding Academic Research Consortium（BARC）类型 2 至 5 级出血。从 PCI 指数后 1 至 12 个月评估结局。
结果
在 3364 例无事件患者中，有 1462 例（43%）接受 OAC 治疗。在 OAC 患者中，1 个月与 3 个月 DAPT 的死亡或 MI 风险相似（7.4%比 8.8%；调整后的 HR：0.74；95%CI：0.49-1.11；P=0.139），而 1 个月 DAPT 时 BARC 类型 2 至 5 级出血发生率较低（调整后的 HR：0.71；95%CI：0.51-0.99；P=0.046）。在有 OAC 和无 OAC 的患者中，这些效果一致（P 交互=NS）。
结论
在 PCI 后 1 至 12 个月期间，与 3 个月 DAPT 相比，1 个月 DAPT 与全因死亡或 MI 发生率相似，BARC 类型 2 至 5 级出血发生率降低，无论是否接受 OAC 治疗。
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