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Abbreviated versus standard dual antiplatelet therapy times after percutaneous coronary intervention in patients with high bleeding risk with acute coronary syndrome : Insights from the swedeheart registry

Hakansson, Anton ; Koul, Sasha LU ; Omerovic, Elmir ; Andersson, Jonas ; James, Stefan ; Agewall, Stefan ; Mokhtari, Arash LU ; Van Der Pals, Jesper LU ; Wester, Axel LU and Szummer, Karolina , et al. (2024) In Journal of the American Heart Association 13(13).
Abstract

BACKGROUND: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention. METHODS AND RESULTS: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at... (More)

BACKGROUND: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention. METHODS AND RESULTS: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88–1.11], P=0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94–1.25]), or their components between groups. The results were consistent among all of the investigated subgroups. CONCLUSIONS: In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndrome, Dual antiplatelet therapy, High bleeding risk, Percutaneous coronary intervention, SWEDEHEART
in
Journal of the American Heart Association
volume
13
issue
13
article number
e034709
publisher
Wiley-Blackwell
external identifiers
  • pmid:38934886
  • scopus:85198040612
ISSN
2047-9980
DOI
10.1161/JAHA.124.034709
language
English
LU publication?
yes
id
de8f7561-4d01-4fb5-bb5f-01e8cff1a7ef
date added to LUP
2024-09-26 15:15:43
date last changed
2024-09-26 15:16:06
@article{de8f7561-4d01-4fb5-bb5f-01e8cff1a7ef,
  abstract     = {{<p>BACKGROUND: Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention. METHODS AND RESULTS: Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88–1.11], P=0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94–1.25]), or their components between groups. The results were consistent among all of the investigated subgroups. CONCLUSIONS: In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.</p>}},
  author       = {{Hakansson, Anton and Koul, Sasha and Omerovic, Elmir and Andersson, Jonas and James, Stefan and Agewall, Stefan and Mokhtari, Arash and Van Der Pals, Jesper and Wester, Axel and Szummer, Karolina and Jernberg, Tomas and Erlinge, David and Mohammad, Moman A.}},
  issn         = {{2047-9980}},
  keywords     = {{Acute coronary syndrome; Dual antiplatelet therapy; High bleeding risk; Percutaneous coronary intervention; SWEDEHEART}},
  language     = {{eng}},
  number       = {{13}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Abbreviated versus standard dual antiplatelet therapy times after percutaneous coronary intervention in patients with high bleeding risk with acute coronary syndrome : Insights from the swedeheart registry}},
  url          = {{http://dx.doi.org/10.1161/JAHA.124.034709}},
  doi          = {{10.1161/JAHA.124.034709}},
  volume       = {{13}},
  year         = {{2024}},
}