Long-term DAPT linked to significant reduction in MACE in patients undergoing complex PCI
MONDAY, Aug. 29, 2016 (HealthDay News) — The safety of dual antiplatelet therapy (DAPT) duration varies with percutaneous coronary intervention (PCI) complexity, according to research published online Aug. 29 in the Journal of the American College of Cardiology. The research was published to coincide with the annual European Society of Cardiology Congress, held from Aug. 27 to 31 in Rome.
Gennaro Giustino, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues pooled data from six randomized controlled trials examining DAPT durations after PCI. Data were included for 9,577 patients for whom procedural variables were available, of whom 17.5 percent underwent complex PCI.
The researchers found that patients who underwent complex PCI had a higher risk of major adverse cardiovascular events (MACE) at a median follow-up of 392 days (adjusted hazard ratio, 1.98; 95 percent confidence interval, 1.50 to 2.60). Significant reductions in MACE were seen for long-term versus short-term DAPT in the complex PCI group (adjusted hazard ratio, 0.56; 95 percent confidence interval, 0.35 to 0.89) versus noncomplex PCI (adjusted hazard ratio, 1.01; 95 percent confidence interval, 0.75 to 1.35). For long-term DAPT, the magnitude of the benefit was progressively greater per increase in procedural complexity. Long-term DAPT was associated with elevated bleeding risk, which was equivalent between the groups.
“Alongside other established clinical risk factors, procedural complexity is an important parameter to take into account in tailoring upfront duration of DAPT,” the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical device industries; Medtronic provided the data for the OPTIMIZE trial.
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