Reduced Mortality With Antiplatelet Therapy Deescalation After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis.

Autor:	Palmerini T; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Bruno AG; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Gasparini M; Dipartimento di Scienze Matematiche, Politecnico di Torino, Italy (M.G., G.R.)., Rizzello G; Dipartimento di Scienze Matematiche, Politecnico di Torino, Italy (M.G., G.R.)., Kim HS; Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea (H.-S.K., J.K., K.-W.P.)., Kang J; Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea (H.-S.K., J.K., K.-W.P.)., Park KW; Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea (H.-S.K., J.K., K.-W.P.)., Hahn JY; Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.-Y.H., Y.B.S., H.-C.G.)., Song YB; Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.-Y.H., Y.B.S., H.-C.G.)., Gwon HC; Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.-Y.H., Y.B.S., H.-C.G.)., Choo EH; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of South Korea (E.H.C., K.C.)., Park MW; Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of South Korea (M.-W.P.)., Kim CJ; Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of South Korea (C.J.K.)., Chang K; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of South Korea (E.H.C., K.C.)., Cuisset T; Department of Cardiology, CHU Timone, Marseille, France (T.C.)., Taglieri N; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Kim BK; Division of Cardiology, Yonsei University Severance Cardiovascular Hospital, Seoul, South Korea (B.-K.K.)., Jang Y; Department of Cardiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea (Y.J.)., Nardi E; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Saia F; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Orzalkiewicz M; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Chietera F; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Ghetti G; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Galiè N; Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)., Stone GW; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2022 Nov; Vol. 15 (11), pp. 906-914. Date of Electronic Publication: 2022 Nov 15.
DOI:	10.1161/CIRCINTERVENTIONS.122.012245
Abstrakt:	Background: Antiplatelet therapy deescalation has been suggested as an alternative to standard treatment with potent dual antiplatelet therapy (DAPT) for 1 year in low bleeding risk patients with acute coronary syndromes undergoing percutaneous coronary intervention to mitigate the increased risk of bleeding. Whether this strategy preserves the ischemic and survival benefits of potent DAPT is uncertain. Methods: We performed a pairwise meta-analysis in patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with either 1-year standard potent DAPT versus deescalation therapy (potent DAPT for 1-3 months followed by either reduced potency DAPT or ticagrelor monotherapy for up to 1 year). Randomized trials comparing standard DAPT versus deescalation therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary end point was 1-year all-cause mortality. Results: The meta-analysis included 6 trials in which 20 837 patients were randomized to potent DAPT for 1 to 3 months followed by deescalation therapy for up to 1 year (n=10 392) or standard potent DAPT for 1 year (n=10 445). Deescalation therapy was associated with lower 1-year rates of all-cause mortality compared with standard therapy (odds ratio, 0.75 [95% CI, 0.59-0.95]; P =0.02). Deescalation therapy was also associated with lower rates of major bleeding (odds ratio, 0.59 [95% CI, 0.48-0.72]; P <0.0001), with no significant difference in major adverse cardiac events (major adverse cardiovascular events; odds ratio, 0.89 [95% CI, 0.77-1.04]; P =0.14). Conclusions: In low bleeding risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, compared with 1-year of potent DAPT, antiplatelet therapy deescalation therapy after 1 to 3 months was associated with decreased mortality and major bleeding with similar rates of major adverse cardiovascular events.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu