Corballis Natasha, Bhalraam U, Merinopoulos Ioannis, Gunawardena Tharusha, Tsampasian Vasiliki, Wickramarachchi Upul, Eccleshall Simon, Vassiliou Vassilios S
Centre of Metabolic Health, Norwich Medical School, University of East Anglia, Bob Champion Research and Education, Rosalind Franklin Road, Norwich NR4 7UQ, UK.
Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7LJ, UK.
J Clin Med. 2024 Aug 2;13(15):4521. doi: 10.3390/jcm13154521.
: The need to determine the safest duration of dual antiplatelet therapy duration after elective angioplasty to reduce bleeding events without an adverse effect on major adverse cardiovascular events (MACE) remains a challenge. : In this investigator-initiated, single-centre cohort study, we identified all patients who underwent PCI for de novo coronary disease for stable angina between January 2015 and November 2019. We compared 1-month and 12-month durations of dual antiplatelet therapy (DAPT) to determine if there was any difference in the primary outcome of major bleeding. The secondary outcome was a patient-oriented composite endpoint of all-cause mortality; any myocardial infarction, stroke, or revascularisation; and the individual components of this composite endpoint. Data were analysed using Cox regression models and cumulative hazard plots. : A total of 1025 patients were analysed, of which 340 received 1 month of DAPT and 685 received 12 months of DAPT. There was no difference in major bleeding between the two groups (2.6% vs. 2.5% respectively). On univariable cox regression analysis, no characteristics were predictors of major bleeding. A proportion of 99.7% of patients in the 1-month DAPT arm were treated with a DCB strategy, whilst 93% in the 12-month DAPT group were treated with a DES. There was no difference between the two groups with regards to the composite patient-oriented MACE (11% vs. 12%, respectively) or any individual component of this. These results were unchanged after propensity score matched analysis. : A 1-month duration of DAPT, for which 99.7% of patients were treated with a DCB strategy, appears safe and effective when compared with a 12-month duration of DAPT with no difference in major bleeding or MACE.
确定择期血管成形术后双联抗血小板治疗的最安全持续时间以减少出血事件且不影响主要不良心血管事件(MACE)仍然是一项挑战。
在这项由研究者发起的单中心队列研究中,我们纳入了2015年1月至2019年11月期间因新发冠心病行PCI治疗稳定型心绞痛的所有患者。我们比较了1个月和12个月的双联抗血小板治疗(DAPT)持续时间,以确定主要出血的主要结局是否存在差异。次要结局是一个以患者为导向的全因死亡率复合终点;任何心肌梗死、中风或血运重建;以及该复合终点的各个组成部分。使用Cox回归模型和累积风险图进行数据分析。
总共分析了1025例患者,其中340例接受了1个月的DAPT,685例接受了12个月的DAPT。两组之间的主要出血无差异(分别为2.6%和2.5%)。在单变量Cox回归分析中,没有特征是主要出血的预测因素。1个月DAPT组中99.7%的患者采用药物涂层球囊(DCB)策略治疗,而12个月DAPT组中93%的患者采用药物洗脱支架(DES)治疗。两组在以患者为导向的复合MACE方面(分别为11%和12%)或其任何单个组成部分方面没有差异。倾向得分匹配分析后这些结果不变。
与12个月的DAPT相比,1个月的DAPT持续时间(99.7%的患者采用DCB策略治疗)似乎安全有效,在主要出血或MACE方面没有差异。