Data di Pubblicazione:
2022
Abstract:
BACKGROUND Nonadherence to antiplatelet therapy after percutaneous coronary intervention (PCI) is common, even in clinical trials.OBJECTIVES The purpose of this study was to investigate the impact of nonadherence to study protocol regimens in the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen) trial.METHODS At 1-month after PCI, 4,579 high bleeding risk patients were randomized to single antiplatelet therapy (SAPT) for 11 months (or 5 months in patients on oral anticoagulation [OAC]) or dual antiplatelet therapy (DAPT) for >= 2 months followed by SAPT. Coprimary outcomes included net adverse clinical events (NACE), major adverse cardiac and cerebral events (MACE), and major or clinically relevant nonmajor bleeding (MCB) at 335 days. Inverse probability-ofcensoring weights were used to correct for nonadherence Academic Research Consortium type 2 or 3.RESULTS In total, 464 (20.2%) patients in the abbreviated-treatment and 214 (9.4%) in the standard-treatment groups incurred nonadherence Academic Research Consortium type 2 or 3. At inverse probability-of-censoring weights analyses, NACE (HR: 1.01; 95% CI: 0.88-1.27) or MACE (HR: 1.07; 95% CI: 0.83-1.40) did not differ, and MCB was lower with abbreviated compared with standard treatment (HR: 0.51; 95% CI: 0.60-0.73) consistently across OAC subgroups; among OAC patients, SAPT discontinuation 6 months after PCI was associated with similar MACE and lower MCB (HR: 0.47; 95% CI: 0.22-0.99) compared with SAPT continuation.CONCLUSIONS In the MASTER DAPT adherent population, 1-month compared with >= 3-month DAPT was associated with similar NACE or MACE and lower MCB. Among OAC patients, SAPT discontinuation after 6 months was associated with similar MACE and lower MCB than SAPT continuation (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020); (C) 2022 by the American College of Cardiology Foundation.
Tipologia CRIS:
14.a.1 Articolo su rivista
Keywords:
P2Y(12) inhibitor; acetylsalicylic acid; drug-eluting stent; dual antiplatelet therapy; high bleeding risk
Elenco autori:
Valgimigli, Marco; Frigoli, Enrico; Vranckx, Pascal; Ozaki, Yukio; Morice, Marie-Claude; Chevalier, Bernard; Onuma, Yoshinobu; Windecker, Stephan; Delorme, Laurent; Kala, Petr; Kedev, Sasko; Abhaichand, Rajpal K; Velchev, Vasil; Dewilde, Willem; Podolec, Jakub; Leibundgut, Gregor; Topic, Dragan; Schultz, Carl; Stankovic, Goran; Lee, Astin; Johnson, Thomas; Tonino, Pim A L; Klotzka, Aneta; Lesiak, Maciej; Lopes, Renato D; Smits, Pieter C; Heg, Dik; Valgimigli, M; C Smits, P; A Van Es, G; G B W, E Vos; Spitzer, E; Vrancks, P; Chevalier, B; Ozaki, Y; C Morice, M; Windecker, S; Onuma, Y; Frigoli, E; Frenk, A; Jüni, P; Tijssen, J; Paunovic, D; S Ajit, M; Alasnag, M; Bartunek, J; Colombo, A; Hildick-Smith, D; Iñiguez, A; Mahfoud, F; Kornowski, R; Lesiak, M; J Ong, P; E Rodriguez, A; Roffi, M; Schultz, C; Stankovic, G; Tonino, P; Moschovitis, Aris; Laanmets, Peep; Donahue, Michael; Bertrand, M; Pocock, S; Urban, P; Leonardi, S; Hanet, C; Lopes, R; P McFadden, E; Radke, P; O Roine, R; Ladan, Boudijn; Laura van der Waal, ; Engelbrecht, Yvonne; Paddenburg, Fred; Ren, Ben; Ingrid de Zwart, ; Elshout, Liliane; Jonk, Judith; Rademaker-Havinga, Tessa; Ria van Vliet, ; Phani Krishna Kondamudi, ; Morsiani, Laure; Windhövel, Ute; Anita van der Wal, ; Bakker, Chantal; Minagawa, Kazuhiro; Mieres, Juan; Cura, Fernando; Fernandez-Pereira, Carlos; Lee, Astin; Jepson, Nigel; Whitbourn, Robert; Owen Christopher Raffel, ; Huber, Kurt; Weidinger, Franz; Fazila-Tun-Nesa Malik Hasselt, ; Ziekenhuis, Jessa; Vranckx, Pascal; Ziekenhuis, Imelda; Dewilde, Willem; Aminian, Adel; Aalst, Emanuele; Pourbai, Suzanne; Xaplanteris, Panagiotis; Velchev, Vasil; Karageorgiev, Dimitar; Mateev, Hristo; Gelev, Valeri; Kala, Petr; Mates, Martin; Kelbæk, Henning; Hovasse, Thomas; Delorme, Laurent; Cuisset, Thomas; Belle, Loïc; Beygui, Farzin; Piot, Christophe; Jean François Morelle, ; Koning, Rene; Valla, Mathieu; Brunel, Philippe; Cayla, Guillaume; Teiger, Emmanuel; Montalescot, Gilles; Spaulding, Christian; Guyon, Phillipe; Stylianos, Pyxaras; Merkely, B; Ungi, Imre; Rajpal, K Abhaichand; Atul Damodar Abhyankar, ; Sengottuvelu, G; Majdi, Halabi; Roguin, Ariel; Feld, Yair; Lotan, Chaim; Garducci, Stefano; Reimers, Bernhard; Sardella, Gennaro; Milan, Antonio; Chieffo, Alaide; Tamburino, Corrado; Andò, Giuseppe; Testa, Luca; Maurizio Di Biasi, ; Sciahbasi, Alessandro; Calabro, Paolo; Minervini, Gianluigi; Loi, Bruno; Fabbiocchi, Franco; Oreglia, Jacopo; Sganzerla, Paolo; Ozaki, Yukio; Ando, Kenji; Higuchi, Yoshiharu; Nanasato, Mamoru; Ishibashi, Yuki; Matsuo, Hitoshi; Yoshida, Ruka; Shimizu, Kiyokazu; Kamiya, Haruo; Komiyama, Nobuyuki; Amano, Tetsuya; Murohara, Toyoaki; Yamazaki, Seiji; Noor, Husam; Kedev, Sasko; Podolec, Jakub; Reszuch, Krzysztof; Wlodarczak, Adrian; Dudek, Dariusz; Pedro Canas da Silva, ; Mangovski, Ljupco; Topic, Dragan; Debeijacki, Dragan; Paul Ong Jau Lueng, ; Syed Saqib Imran, ; Seung-Jung, Park; Jose Francisco Diaz Fernandez, ; Brudo Garcia Del Blanco, ; Mainar, Vicente; Ivan Gomez Blazquez, ; Pinar, Eduardo; Javier Escaned Barbosa, ; Antoni, Joan; Sainz, Fermin; Goicolea, Javier; Fröbert, Ole; Kastberg, Robert; Leibundgut, Gregor; Pedrazzini, Giovanni; Garachemani, Ali; Siegrist, Patrick; Cook, Stephane; Mafragi, Al; Jessurun, G; Ruifrok, W; Danse, Peter; Polad, J; Kauer, Floris; Clemens von Birgelen, ; Jurrien Ten Berg, ; Ijsselmuiden, Sander; Somi, Samer; Johnson, Tom; Routledge, Helen; Din, Jehangir; Munir, Shahzad; Mcdonald, John; Kikreja, Neville; Mamas, Mamas; Das, Rajiv; Contractor, Hussain; Peace, Aaron; Williams, Rupert; Nguyen Ngoc Quang,
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