Incidence of Adverse Events at 3 Months Versus at 12 Months After Dual Antiplatelet Therapy Cessation in Patients Treated With Thin Stents With Unprotected Left Main or Coronary Bifurcations.
Autor: | D'Ascenzo F; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; Division of Cardioloy, Universityspirtal of Zürich, Zürich, Switzerland., Barbero U; Ospedale Civile SS. Annunziata, Savigliano, Italiy, Via Ospedali, 9, 12038., Abdirashid M; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy. Electronic address: baashi90@gmail.com., Trabattoni D; Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy; University of Milan, Milan, Italy., Boccuzzi G; Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy., Ryan N; Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain., Quadri G; Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Capodanno D; Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria 'Policlinico-Vittorio Emanuele,' Catania, Italy., Venuti G; Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria 'Policlinico-Vittorio Emanuele,' Catania, Italy., Muscoli S; San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Tomassini F; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Autelli M; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Montabone A; Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy., Wojakowski W; Department of Cardiology, Medical University of Silesia, Katowice, Poland., Rognoni A; Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della Carità, Novara, Italy., Gallo D; Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, and Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom., Parma R; University Clinical Hospital, Warsaw, Poland., De Luca L; Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Italy., Figini F; Pederzoli Hospital, Peschiera del Garda, Italy., Mitomo S; San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Montefusco A; Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy., Mattesini A; Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy., Wańha W; Department of Cardiology, Medical University of Silesia, Katowice, Poland., Protasiewicz M; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Smolka G; Department of Cardiology, Medical University of Silesia, Katowice, Poland., Huczek Z; University Clinical Hospital, Warsaw, Poland., Rolfo C; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Cortese B; Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy., Chieffo A; San Raffaele Scientific Institute, Milan, Italy., Kuliczowki W; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Nuñez-Gil I; Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain., Morbiducci U; Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, and Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom., Ugo F; Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy., Marengo G; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Iannaccone M; Ospedale Civile SS. Annunziata, Savigliano, Italiy, Via Ospedali, 9, 12038., Cerrato E; Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Mario CD; Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy., Moretti C; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., D'Amico M; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Varbella F; Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., Lüscher TF; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Sheiban I; Pederzoli Hospital, Peschiera del Garda, Italy., Escaned J; Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain., Romeo F; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy., Rinaldi M; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., De Ferrari GM; Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy., Helft G; Pierre and Marie Curie University, Paris, France. |
---|---|
Jazyk: | angličtina |
Zdroj: | The American journal of cardiology [Am J Cardiol] 2020 Feb 15; Vol. 125 (4), pp. 491-499. Date of Electronic Publication: 2019 Nov 23. |
DOI: | 10.1016/j.amjcard.2019.10.058 |
Abstrakt: | Incidence and predictors of adverse events after dual antiplatelet therapy (DAPT) cessation in patients treated with thin stents (<100 microns) in unprotected left main (ULM) or coronary bifurcation remain undefined. All consecutive patients presenting with a critical lesion of an ULM or involving a main coronary bifurcation who were treated with very thin strut stents were included. MACE (a composite end point of cardiovascular death, myocardial infarction [MI], target lesion revascularization [TLR], and stent thrombosis [ST]) was the primary endpoint, whereas target vessel revascularization (TVR) was the secondary endpoint, with particular attention to type and occurrence of ST and occurrence of ST, CV death, and MI during DAPT or after DAPT discontinuation. All analyses were performed according to length of DAPT dividing the patients in 3 groups: Short DAPT (3-months), intermediate DAPT (3 to 12 months), and long DAPT (12-months). A total of 117 patients were discharged with an indication for DAPT ≤3 months (median 1: 1 to 2.5), 200 for DAPT between 3 and 12 months (median 8: 7 to 10), and 1,958 with 12 months DAPT. After 12.8 months (8 to 20), MACE was significantly higher in the 3-month group compared with 3 to 12 and 12-month groups (9.4% vs 4.0% vs 7.2%, p ≤0.001), mainly driven by MI (4.4% vs 1.5% vs 3%, p ≤0.001) and overall ST (4.3% vs 1.5% vs 1.8%, p ≤0.001). Independent predictors of MACE were low GFR and a 2 stent strategy. Independent predictors of ST were DAPT duration <3 months and the use of a 2-stent strategy. In conclusion, even stents with very thin strut when implanted in real-life ULM or coronary bifurcation patients discharged with short DAPT have a relevant risk of ST, which remains high although not significant after DAPT cessation. (Copyright © 2019 Elsevier Inc. All rights reserved.) |
Databáze: | MEDLINE |
Externí odkaz: |