One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes

Cao, D; Vranckx, P; Valgimigli, M; Sartori, S; Angiolillo, DJ; Bangalore, S; Bhatt, DL; Feng, Y; Ge, J; Hermiller, J; Makkar, RR; Neumann, FJ; Saito, S; Picon, H; Toelg, R; Maksoud, A; Chehab, BM; Choi, JW; Campo, G; De la Torre Hernandez, JM; Krucoff, MW; Kunadian, V; Sardella, G; Spirito, A; Thiele, H; Varenne, O; Vogel, B; Zhou, Y; Windecker, S; Mehran, R

doi:10.4244/eij-d-23-00658

One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes

EuroInterventionPublished 20 May 2024Prespecified analysis of the XIENCE Short dual antiplatelet therapy (DAPT) programme

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Authors' conclusion

Among HBR patients undergoing implantation of an everolimus-eluting stent, 1-month, compared to 3-month DAPT, was associated with similar ischaemic risk and reduced bleeding at 1 year, irrespective of clinical presentation.

Study context

Population: High bleeding risk (HBR) patients after cobalt-chromium everolimus-eluting stent implantation, with or without NSTE-ACS1,164 (34.6%) with NSTE-ACS
Participants: 3,364 patients

Comparison: 1-month vs 3-month DAPT, by clinical presentation
1-month DAPTn = 1,392
3-month DAPTn = 1,972reference
Primary endpoint: Death or MI
Follow-up: 12 months

Methodological detailsthree prospective single-arm studies, international, propensity score stratification

Three prospective single-arm studies
International
Propensity score stratification

Primary result

As reported in the abstract

Death or MI, by clinical presentation (subgroup analysis)

1-month DAPT vs 3-month DAPTHazard ratio (95% CI)

With NSTE-ACS

1.09(0.71–1.65)

Without NSTE-ACS

0.88(0.63–1.23)

Safety

Outcome	← Lower risk with 1-month DAPT ←→ Higher risk with 1-month DAPT →	HR (95% CI)
BARC type 2-5 bleeding (key secondary endpoint), by clinical presentation · 12 months1-month DAPT vs 3-month DAPT · NSTE-ACS	0.20.5125	0.57 (0.37–0.88)
BARC type 2-5 bleeding (key secondary endpoint), by clinical presentation · 12 months1-month DAPT vs 3-month DAPT · stable patients	0.20.5125	0.84 (0.61–1.15)
	0.20.5125Hazard ratio (log scale)

Bleeding Academic Research Consortium (BARC) type 2-5 bleeding (key secondary endpoint), by clinical presentation: p-interaction=0.15

Original publication

One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes. EuroIntervention. Published 20 May 2024. doi:10.4244/eij-d-23-00658

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Summarised from the published abstract; every number is checked against it