Lesion Complexity and Outcomes of Extended Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Yeh, Robert W.; Kereiakes, Dean J.; Steg, P. Gabriel; Cutlip, Donald E.; Croce, Kevin; Massaro, Joseph M.; Mauri, Laura

doi:10.1016/j.jacc.2017.09.011

Cited by 106 publications

(82 citation statements)

References 13 publications

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“…In an individual patient pooled meta-analysis consisting of studies comparing 3–6 months DAPT with 12–24 months DAPT, 12–24 months DAPT was associated with significant reductions in MACE compared with 3–6 months DAPT [38]. Conversely, in the DAPT study among patients without events in the first 12 months, the benefits of extending DAPT beyond one year were similar in subjects with and without complex lesions [39]. These findings suggest that complex PCI may be a more useful discriminator for predicting the benefit of DAPT within the first year after PCI, but less useful for predicting benefit of longer durations after 12 months.…”

Section: Available Evidencementioning

confidence: 99%

Optimal duration of dual antiplatelet therapy for coronary artery disease

Kikkert

Damman

2018

Neth Heart J

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The optimal duration of dual antiplatelet therapy (DAPT) for stable coronary artery disease and acute coronary syndrome is a complex decision. We review current literature on standard duration DAPT versus short duration DAPT (6 months or shorter) or extended duration DAPT (>12 months) after percutaneous coronary intervention with drug-eluting stent placement, and prolonged treatment after 12 months in acute coronary syndrome. Current guideline recommendations are summarised, including the use of risk scores for ischaemic and bleeding risk assessment. Because of the limitations of current risk scores, we propose multiple patient-related and procedure-related factors for the ischaemic and bleeding risk assessment aiding in personalised DAPT duration.

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Section: Available Evidencementioning

confidence: 99%

Optimal duration of dual antiplatelet therapy for coronary artery disease

Kikkert

Damman

2018

Neth Heart J

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“…However, restenosis or ST in the LM lesion could result in serious consequences and may post LM‐PCI patients could benefit from extended duration of dual antiplatelet therapy. Dual antiplatelet therapy beyond 1 year reduced major adverse events without increased bleeding events in complex lesion PCI compared to 1‐year duration of dual antiplatelet therapy . Risk models are available to determine the duration of dual antiplatelet therapy and obtain the maximum net clinical benefit but do not contain information whether patients post LM‐PCI should be on longer duration of therapy .…”

Section: Discussionmentioning

confidence: 99%

“…Dual antiplatelet therapy beyond 1 year reduced major adverse events without increased bleeding events in complex lesion PCI compared to 1-year duration of dual antiplatelet therapy. 40,41 Risk models are available to determine the duration of dual antiplatelet therapy and obtain the maximum net clinical benefit but do not contain information whether patients post LM-PCI should be on longer duration of therapy. 42,43 Further studies are required to elucidate the optimal stenting technique in LM-PCI and duration of antiplatelet therapy.…”

Section: Clinical Presentationmentioning

confidence: 99%

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

Ando

Aoi

Ashraf

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the efficacy and safety of transradial (TR) versus transfemoral (TF) percutaneous coronary intervention (PCI) in left main (LM) lesion. Background TR‐PCI is the preferred approach compared with TF approach because of less bleeding risk. LM‐PCI is often challenging because of the anatomical complexity and uniqueness of supplying a large myocardium territory. We performed a systematic review and meta‐analysis to assess the safety and efficacy of TR‐PCI compared with TF‐PCI of the LM lesions. Methods A comprehensive literature search of PUBMED, EMBASE, and Cochrane database was conducted to identify studies that reported the comparable outcomes between both approaches. Odds ratio (OR) and 95% confidence interval (CI) was calculated using the Mantel–Haenszel method. Results A total of eight studies were included in the quantitative meta‐analysis. TR‐PCI resulted in lower bleeding risk (OR 0.31, 95%CI 0.18–0.52, P < 0.01, I2 = 0%) while maintaining similar procedural success rate, target lesion revascularization, myocardial infarction, stent thrombosis, and all‐cause mortality during the study follow‐up period. Conclusions TR‐PCI may achieve similar efficacy with decreased bleeding risk compared to TF‐PCI in LM lesions. When operator experience and anatomical complexity are favorable, TR approach is an attractive alternative access over TF approach in LM‐PCI.

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“…The study found that a longer DAPT duration significantly increased TIMI major and minor bleeding in patients with higher scores but not in those with lower risk scores ( p interaction = 0.007). Similarly, a scoring system was developed by Yeh et al and used to analyze extended DAPT use of 30 months versus 12 months in patients with complex lesions such including ULM, length >30 mm, and bypass grafts. In the 25 416 patients enrolled, complex target lesions had higher rates of MI/ST in the first 12 months after PCI (3.9% vs 2.4%; P < 0.001).…”

Section: Dual Antithrombotic Therapy After Pcimentioning

confidence: 99%

“…83 The study found that a longer DAPT duration significantly increased TIMI major and minor bleeding in patients with higher scores but not in those with lower risk scores (p interaction = 0.007). Similarly, a scoring system was developed by Yeh et al 84…”

Section: Dual Antithrombotic Therapy After Pcimentioning

confidence: 99%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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Lesion Complexity and Outcomes of Extended Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Cited by 106 publications

References 13 publications

Optimal duration of dual antiplatelet therapy for coronary artery disease

Optimal duration of dual antiplatelet therapy for coronary artery disease

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

Percutaneous coronary intervention: 2017 in review

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