Duration of Antiplatelet Therapy After Complex Percutaneous Coronary Intervention In Patients at High Bleeding Risk: a MASTER DAPT trial sub-analysis

AIMS

To assess the effects of 1- or ≥3-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients who received biodegradable-polymer sirolimus-eluting stents for complex percutaneous coronary intervention (PCI) and/or acute coronary syndrome (ACS).

METHODS AND RESULTS

In the MASTER DAPT trial, 3383 patients underwent noncomplex (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 complex (abbreviated DAPT, n = 588; standard DAPT, n = 608) PCI. Co-primary outcomes at 335 days were net adverse clinical events (NACE; composite of all-cause death, myocardial infarction, stroke, and Bleeding Academic Research Consortium [BARC] 3 or 5 bleeding events); major adverse cardiac or cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and type 2, 3, or 5 BARC bleeding.NACE and MACCE did not differ with abbreviated versus standard DAPT among patients with complex (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively) and noncomplex PCI (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; Pinteraction = 0.60 and 0.26, respectively). BARC 2, 3 or 5 was reduced with abbreviated DAPT in patients with and without complex PCI (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55-0.89; Pinteraction = 0.72). Among the 2,816 patients with complex PCI and/or ACS, NACE and MACCE did not differ and BARC 2, 3 or 5 was lower with abbreviated DAPT.

CONCLUSION

In HBR patients free from recurrent ischemic events at 1 month, DAPT discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity.

Angioplasty of the left main coronary artery: Mid-term follow-up at University Medical Centre Groningen

BACKGROUND

Coronary angioplasty is being increasingly performed in complex lesions of the unprotected and protected left main (LM) coronary artery.

OBJECTIVES

To assess the impact of patient and operator related clinical variables of success and to evaluate the subsequent mid-term effects of percutaneous treatment of LM coronary stenosis.

METHODS

In a tertiary referral, high-volume angioplasty centre a total of 118 consecutive surgical and nonsurgical patients with protected and unprotected LM lesions were treated and evaluated in a retrospective observational study.

RESULTS

There were 57 protected and 61 unprotected patients, including 13 patients with an acute myocardial infarction (AMI). Mean age was 67 years (range 33-90). The length of the stenotic segment was 4.8±2.3 mm, mean lumen diameter 1.1±0.6 mm and percentage diameter stenosis 63.6±14.6%. There were seven (5.9%) in-hospital cardiac deaths which presented with AMI and cardiogenic shock. All seven patients had unprotected LM lesions. Average follow-up was eight months (range 1 to 36 months). Major adverse cardiac events (MACE) during follow-up comprised eight (6.8%) cardiac deaths, three (2.5%) myocardial infarctions, eight (6.8%) subjects with coronary bypass surgery and 16 (13.6%) repeated angioplasties. The total event rate (MACE, n=43) at the end of the follow-up period was 36.4%. There were more MACE in the unprotected group than in the protected group (41 vs. 31.6%, p<0.05).

CONCLUSION

This study supports prior data on LM angioplasty. LM stenting in AMI, however, showed less favourable in-hospital and late outcome.