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Cirillo P, DI Serafino L, Gamra H, Zimarino M, Barbato E, Briguori C, Amat-Santos IJ, Chieffo A, Erglis A, Gil RJ, Kedev SA, Petrov I, Radico F, Niglio T, Nakamura S, Costa RA, Kanic V, Perfetti M, Pellicano M, Maric K, Tesorio T, Vukcevic V, Esposito G, Stankovic G. Impact of dual antiplatelet therapy duration on clinical outcome after coronary bifurcation stenting: results from the EuroBifurcation Club registry. Panminerva Med 2023; 65:1-12. [PMID: 35546730 DOI: 10.23736/s0031-0808.22.04604-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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 Bleeding Academic Research Consortium (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.
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Affiliation(s)
- Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy -
| | - Luigi DI Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Habib Gamra
- Department of Cardiology, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Marco Zimarino
- Institute of Cardiology, G. D'Annunzio University, Chieti, Italy.,Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
| | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | | | - Alaide Chieffo
- Unit of Interventional Cardiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Robert J Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Sasko A Kedev
- University Clinic of Cardiology Skopje, Skopje, Macedonia
| | | | - Francesco Radico
- Institute of Cardiology, G. D'Annunzio University, Chieti, Italy
| | - Tullio Niglio
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Vojko Kanic
- Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia
| | | | - Mariano Pellicano
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain.,Laboratory of Invasive Cardiology, Montevergine Clinic, Mercogliano, Avellino, Italy
| | - Kristina Maric
- Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia
| | - Tullio Tesorio
- Laboratory of Invasive Cardiology, Montevergine Clinic, Mercogliano, Avellino, Italy
| | - Vladan Vukcevic
- Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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Di Serafino L, Gamra H, Cirillo P, Zimarino M, Amat-Santos IJ, Barbato E, Briguori C, Chieffo A, Ergilis A, Gil RJ, Kedev SA, Petrov I, Radico F, Nakamura S, Stankovic G. P1962Impact of Dual Antiplatelet Therapy duration on clinical outcome after stent implantation for coronary bifurcation lesions: results from the Euro Bifurcation Club - P2BiTO - registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Duration of Dual Antiplatelet Therapy (DAPT) following Acute Coronary Syndromes (ACS) or Stable Coronary Artery Disease (SCAD) treated with coronary stenting is still debated. Although current guidelines consider several “clinical” criteria to decide for short DAPT (<6 months), standard DAPT (12 months) and prolonged DAPT (>12 months), the relationship between DAPT duration, treatment of bifurcations and its impact on clinical outcome has been poorly investigated in real world registries.
Purpose
We evaluated the impact of DAPT duration on clinical outcomes in consecutive all-comers patients treated with stenting of coronary artery bifurcation lesions included in the Euro Bifurcation Club -P2BiTO - registry.
Methods
Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centres between January 2012 and December 2014 were collected. The primary endpoint of the study was the cumulative occurrence of Major Adverse Cardiac Events (MACCE), defined as a composite of overall-death death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke during the follow-up; the secondary endpoints were the single occurrence of any of the above mentioned events.
Results
Data on DAPT duration was available for 3992 patients (79%). Patients were divided into 3 groups: Group 1) DAPT <6-months (n=720); Group 2) DAPT >6-months but <12-month (n=1602); Group 3) DAPT >12-months (n=1670). Follow up was completed in 3935 (98%) patients with a median of 20 months (C.I.=12–28). At 24 months after the index procedure, MACCE occurred more frequently in the DAPT <6-month group (Group 1) as compared with both Group 2 and 3 (respectively, 102 (14%) versus 154 (10%) and 164 (10%), HR: 0.72 (0.64–0.82), p<0.001). This difference remains after adjustment for clinical and angiographic characteristics (HR: 0.66 (0.58–0.77), p<0.001). On the contrary, no significant difference was found between Group 2 and Group 3 patients. At the Kaplan-Meier analysis (Figure 1), freedom from MACCE survival was significantly lower in patients receiving DAPT for less than 6 months (Log-Rank: 29.5, p<0.001).
Figure 1. Kaplan-Meier curves
Conclusions
In the P2BiTO registry, short DAPT duration of less than 6 months was associated with a significantly higher risk of MACCE compared to longer DAPT in a real-world registry of patients treated for coronary artery bifurcation stenosis.
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Affiliation(s)
| | - H Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - P Cirillo
- Federico II University Hospital, Division of Cardiology - Dpt of Advanced Biomedical Sciences, Naples, Italy
| | | | | | - E Barbato
- Federico II University Hospital, Division of Cardiology - Dpt of Advanced Biomedical Sciences, Naples, Italy
| | | | - A Chieffo
- San Raffaele Scientific Institute, Milan, Italy
| | - A Ergilis
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | - R J Gil
- Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - S A Kedev
- Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | | | - F Radico
- G. d Annunzio University, Chieti, Italy
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Cortes Villar C, Vera Vera S, Goncalves LR, Ramos B, Serrador A, Gutierrez H, Carrasco M, Gomez I, San Roman JA, Amat-Santos IJ. P4625Functional evolution of non-culprit lesions in acute myocardial infarction. A quantitative flow ratio study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - S Vera Vera
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - L R Goncalves
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - B Ramos
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - A Serrador
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - H Gutierrez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - M Carrasco
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - I Gomez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - J A San Roman
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
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Cortes Villar C, Jaguszewski M, Schincariol M, Amat-Santos IJ, Franco-Pelaez JA, Ciecwierz D, Wojakowski W, Navarro F, Mischke K, San Roman JA, Ibanez B, Gutierrez-Chico JL. P4637A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure during balloon inflation: the APIS-S pilot study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Jaguszewski
- Medical University of Gdansk, First Department of Cardiology, Gdansk, Poland
| | - M Schincariol
- Leopoldina Hospital, Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Schweinfurt, Germany
| | | | | | - D Ciecwierz
- Medical University of Gdansk, First Department of Cardiology, Gdansk, Poland
| | - W Wojakowski
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - F Navarro
- Foundation Jimenez Diaz, Madrid, Spain
| | - K Mischke
- Leopoldina Hospital, Schweinfurt, Germany
| | - J A San Roman
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - B Ibanez
- Foundation Jimenez Diaz, Madrid, Spain
| | - J L Gutierrez-Chico
- Leopoldina Hospital, Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Schweinfurt, Germany
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