1- Versus 3-Month DAPT in Older Patients at a High Bleeding Risk Undergoing PCI: Insights from the XIENCE Short DAPT Global Program

• Published in: The American journal of cardiology Vol. 214; pp. 94 - 104
• Main Authors: Sardella, Gennaro, Spirito, Alessandro, Sartori, Samantha, Angiolillo, Dominick J., Vranckx, Pascal, Hernandez, Jose M. De la Torre, Krucoff, Mitchell W., Bangalore, Sripal, Bhatt, Deepak L., Campo, Gianluca, Cao, Davide, Chehab, Bassem M., Choi, James W., Feng, Yihan, Ge, Junbo, Godfrey, Katherine, Hermiller, James, Kunadian, Vijay, Makkar, Raj R., Maksoud, Aziz, Neumann, Franz-Josef, Picon, Hector, Saito, Shigeru, Thiele, Holger, Toelg, Ralph, Varenne, Olivier, Vogel, Birgit, Zhou, Yujie, Valgimigli, Marco, Windecker, Stephan, Mehran, Roxana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024; Elsevier Limited
• Subjects: Age; Aged; Anemia; Antiplatelet therapy; Bleeding; Cardiovascular disease; Consortia; Coronary vessels; Creatinine; Death; Drug Therapy, Combination; Drug-Eluting Stents; dual antiplatelet therapy; elderly; Heart attacks; Hemoglobin; Hemorrhage - chemically induced; Hemorrhage - epidemiology; high bleeding risk; Humans; Implants; Ischemia; Mortality; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - epidemiology; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Risk; Stents; Stroke; Treatment Outcome; United States > US; dual antiplatelet therapy; percutaneous coronary intervention; high bleeding risk; elderly
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2023.12.049

This analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from 3 prospective, single-arm studies (XIENCE Short DAPT Program), including patients with high bleeding risk successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and <75 years). The primary end point was all-cause death or myocardial infarction (MI). The key secondary end point was Bleeding Academic Research Consortium type 2 to 5 bleeding. The outcomes were assessed from 1 to 12 months after index PCI. Of 3,364 patients, 2,241 (66.6%) were aged ≥75 years. The risk of death or MI was similar with 1- versus 3-month DAPT in patients aged ≥75 (8.5% vs 8.0%, adjusted hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.69 to 1.30) and <75 years (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60 to 1.57, interaction p = 0.478). Bleeding Academic Research Consortium type 2 to 5 bleeding was consistently lower with 1- than with 3-month DAPT in patients aged ≥75 years (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48 to 0.91) and <75 years (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57 to 1.29, interaction p = 0.737). In conclusion, in patients at high bleeding risk who underwent PCI, patients older and younger than 75 years derived a consistent benefit from 1- compared with 3-month DAPT in terms of bleeding reduction, with no increase in all-cause death or MI at 1 year.