Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014–2019)

Abstract

Backgroundwhile the duration of dual antiplatelet therapy (DAPT) following coronary angioplasty for chronic coronary syndrome (CCS) recommended by the European Society of Cardiology has decreased over the last decade, little is known about the adherence to those guidelines in clinical practice in France.AimTo analyze the real duration of DAPT post coronary angioplasty in CCS, as well as the factors affecting this duration.MethodsBetween 2014 and 2019, 8.836 percutaneous coronary interventions for CCS from the France-PCI registry were evaluated, with 1 year follow up, after exclusion of patients receiving oral anticoagulants, procedures performed within one year of an acute coronary syndrome, and repeat angioplasty.ResultsPost-percutaneous coronary intervention (PCI) DAPT duration was > 12 months for 53.1% of patients treated for CCS; 30.5% had a DAPT between 7 and 12 months, and 16.4% a DAPT ≤ 6 months. Patients with L-DAPT (>12 months) were at higher ischemic risk [25.0% of DAPT score ≥2 vs. 18.8% DAPT score ≥2 in S&I-DAPT group (≤12 months)]. The most commonly used P2Y12 inhibitor was clopidogrel (82.2%). The prescription of ticagrelor increased over the period.Conclusionspost-PCI DAPT duration in CCS was higher than international recommendations in the France PCI registry between 2014 and 2019. More than half of the angioplasty performed for CCS are followed by a DAPT > 12 months. Ischemic risk assessment influences the duration of DAPT. This risk is probably overestimated nowadays, leading to a prolongation of DAPT beyond the recommended durations, thus increasing the bleeding risk.

Safety and efficacy of NOAC vs. VKA in patients treated by PCI: a retrospective study of the FRANCE PCI registry

“…France PCI is a fully electronic, daily updated, high-quality, and low-cost national multicenter observational registry that includes consecutive patients undergoing coronary angiogram and/or PCI in 47 French centers ( 8 , 9 ). France PCI is registered at clinicaltrials.org (NCT02778724) and all participants are informed of data collection and of the aims of the survey.…”

Demystifying the Contemporary Role of 12-Month Dual Antiplatelet Therapy After Acute Coronary Syndrome

“…[1][2][3][4][5][6] Several population registries show that 12 months is the most frequently prescribed DAPT duration in patients with-and frequently also withoutacute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). [7][8][9][10][11][12] The initial recommendation of 12-month DAPT duration was derived from the few available studies as well as concern regarding increased ischemic risk after stent implantation. 13 In recent years, technologic advancements, improvements in stent design, 14 and increasing use of intravascular imaging 15 have significantly reduced the risk of ischemic recurrences after PCI, making the 12-month DAPT paradigm less relevant for stent thrombosis prevention than in the past.…”