使用第三代药物洗脱支架进行复杂经皮冠状动脉介入治疗后的短期双联抗血小板治疗：HOST-IDEA试验的事后分析
Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial.
作者信息
Han Jung-Kyu, Lee Keehwan, Park Sang-Hyeon, Yang Seokhun, Hwang Doyeon, Kang Jeehoon, Yang Han-Mo, Park Kyung Woo, Kang Hyun-Jae, Koo Bon-Kwon, Hur Seung-Ho, Kim Weon, Park Sang-Hyun, Han Seung Hwan, Kim Sang-Hyun, Kim Yong Hoon, Lee Namho, Lee Seung Jin, Shin Sanghoon, Kim Hyo-Soo
机构信息
Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., K.L., Sang-Hyeon Park, S.Y., D.H., J.K., H.-M.Y., K.W.P., H.-J.K., B.-K.K., H.-S.K.).
Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M.Y., K.W.P., H.-J.K., B.-K.K., S.-H.K., H.-S.K.).
出版信息
Circ Cardiovasc Interv. 2025 May;18(5):e014623. doi: 10.1161/CIRCINTERVENTIONS.124.014623. Epub 2025 Mar 31.
BACKGROUND
The optimal duration of dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of DAPT over 12 months after complex PCI.
METHODS
A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months.
RESULTS
Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened DAPT duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403-1.659) for the complex PCI group and 1.282 (95% CI, 0.506-3.249) for the noncomplex PCI group (=0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075-0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627-3.754], showing a significant interaction; =0.029).
CONCLUSIONS
In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of DAPT was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month DAPT.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.
背景
复杂经皮冠状动脉介入治疗（PCI）后双联抗血小板治疗（DAPT）的最佳疗程仍不明确。我们旨在研究复杂PCI后3至6个月DAPT对比12个月DAPT的疗效和安全性。
方法
对HOST-IDEA（冠状动脉狭窄治疗的优化策略——使用新一代药物洗脱支架平台和简化双联抗血小板治疗的冠状动脉介入治疗）随机试验进行事后分析，该试验纳入了接受第三代药物洗脱支架PCI的患者。复杂PCI定义为符合以下任何一项：植入≥3枚支架、治疗≥3处病变、采用双支架置入术的分叉病变PCI、总支架长度≥60 mm、左主干PCI或重度钙化。主要终点为靶病变失败（缺血性结局，包括心源性死亡、靶血管心肌梗死和因临床原因导致的靶病变血运重建的复合终点），以及12个月时的大出血（定义为出血学术研究联盟（BARC）3型或5型出血）。
结果
在1992例患者中，624例接受了复杂PCI。复杂PCI组具有与高出血风险相关的临床特征。缩短DAPT疗程并未增加靶病变失败风险，复杂PCI组的风险比为0.818（95%置信区间，0.403 - 1.659），非复杂PCI组为1.282（95%置信区间，0.506 - 3.249）（P = 0.451）。相反，它降低了复杂PCI组的大出血风险（风险比，0.269 [95%置信区间，0.075 - 0.965]），但未降低非复杂PCI组的大出血风险（风险比，1.534 [95%置信区间，0.627 - 3.754]），显示出显著的交互作用（P = 0.029）。
结论
在接受第三代药物洗脱支架复杂PCI的患者中，与12个月DAPT相比，3至6个月的DAPT疗程与出血风险降低相关，且缺血事件风险未增加。
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