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Original Article   

Panminerva Medica 2022 May 13

DOI: 10.23736/S0031-0808.22.04604-3


lingua: Inglese

Impact of dual antiplatelet therapy duration on clinical outcome after coronary bifurcation stenting: results from the Euro Bifurcation Club registry

Plinio CIRILLO 1 , Luigi DI SERAFINO 1, Habib GAMRA 2, Marco ZIMARINO 3, 4, Emanuele BARBATO 1, 5, Carlo BRIGUORI 6, Ignatio J. AMAT-SANTOS 7, Alaide CHIEFFO 8, Andrejs ERGLIS 9, Robert J. GIL 10, Sasko A. KEDEV 11, Ivo PETROV 12, Francesco RADICO 3, Tullio NIGLIO 1, Sunao NAKAMURA 13, Ricardo A. COSTA 14, Vojko KANIC 15, Matteo PERFETTI 4, Mariano PELLICANO 1, 7, 16, Kristina MARIC 17, Tullio TESORIO 16, Vladan VUKCEVIC 18, Giovanni ESPOSITO 1, Goran STANKOVIC 18, on behalf of The EuroBifurcation Club

1 Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; 2 Cardiology Department, Fattouma Bourguiba Hospital, University of Monastir, Monastor, Tunisia; 3 Institute of Cardiology G. d'Annunzio University, Chieti, Italy; 4 Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy; 5 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; 6 Interventional Cardiology Unit, Clinica Mediterranea, Naples, Italy; 7 CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; 8 Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; 9 Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; 10 Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland; 11 University Clinic of Cardiology Skopje, Skopje, Macedonia; 12 City Clinic, Sofia, Bulgaria; 13 Department of Cardiology, New Tokyo Hospital, Chiba, Japan; 14 Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil; 15 Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia; 16 Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Avellino, Italy; 17 Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia; 18 Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia


BACKGROUND: Optimal duration of Dual Antiplatelet Therapy (DAPT) following percutaneous coronary intervention (PCI) of a bifurcation stenosis is still debated. We evaluated the impact of DAPT duration on clinical outcomes in all-comers patients undergoing bifurcation PCI included in the European Bifurcation Club (EBC) registry.
METHODS: We enrolled 2284 consecutive patients who completed at least 18 months follow-up. The cumulative occurrence of Major Adverse Cardiac and Cardiovascular Events (MACCE), defined as a composite of overall-death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke were evaluated. Bleedings classified as BARC ≥ 3 were evaluated too.
RESULTS: Patients were divided into 3 groups: Short DAPT (<6-months, n=375); Standard DAPT (≥6-months but ≤12-months, n=636); Prolonged DAPT (>12- months, n=1273). At 24 months follow-up MACCE-free survival was significantly lower in Short DAPT patients (Log-Rank: 45.23, p for trend <0.001). MACCE occurred less frequently in the Prolonged DAPT group (148 (11.6%)) as compared with both the Short (83 (22.1%) HR:0.48 (0.37-0.63), p<0.001) and Standard DAPT groups (137 (21.5%) HR:0.51 (0.41-0.65), p<0.001). These differences remain after propensity score adjustment (respectively, HR: 0.27 (0.20-0.36) and HR: 0.44 (0.34-0.57)). Such finding was consistent in patients presenting with both acute and chronic coronary syndromes. BARC ≥ 3 bleedings were 0.3% in the Standard DAPT, 1.6% in Short and 1.9% in Prolonged DAPT groups.
CONCLUSIONS: In the “real-world” EBC registry of patients undergoing PCI of coronary artery bifurcation stenosis, a prolonged DAPT duration was associated with a significantly lower risk of MACCE and a potential increased risk of major bleedings.

KEY WORDS: Bifurcation; DAPT; PCI

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