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
Fabrizio d'Ascenzo
(1, 2, 3)
,
Umberto Barbero
(4)
,
Mohamed Abdirashid
(1)
,
Daniela Trabattoni
(5, 6)
,
Giacomo Boccuzzi
(7)
,
Nicola Ryan
(8)
,
Giorgio Quadri
(9, 10)
,
Davide Capodanno
(11)
,
Giuseppe Venuti
(11)
,
Saverio Muscoli
(12, 13)
,
Francesco Tomassini
(1)
,
Michele Autelli
(1)
,
Andrea Montabone
(14)
,
Wojciech Wojakowski
(15)
,
Andrea Rognoni
(16)
,
Diego Gallo
(17, 18, 19, 20)
,
Radoslaw Parma
(21)
,
Leonardo de Luca
(22)
,
Filippo Figini
(23)
,
Satoru Mitomo
(12, 13)
,
Antonio Montefusco
(14)
,
Alessio Mattesini
(14)
,
Wojciech Wańha
(15)
,
Marcin Protasiewicz
(1)
,
Grzegorz Smolka
(15)
,
Zenon Huczek
(21)
,
Cristina Rolfo
(1)
,
Bernardo Cortese
(24)
,
Alaide Chieffo
(12)
,
Wiktor Kuliczowki
(1)
,
Ivan Nuñez-Gil
(8)
,
Umberto Morbiducci
(17, 19, 20)
,
Fabrizio Ugo
(7)
,
Giorgio Marengo
(1)
,
Mario Iannaccone
(4)
,
Enrico Cerrato
(9, 10)
,
Carlo Di Mario
(14)
,
Claudio Moretti
(1)
,
Maurizio d'Amico
(1)
,
Ferdinando Varbella
(10, 9)
,
Thomas Lüscher
(1)
,
Imad Sheiban
(23)
,
Javier Escaned
(8)
,
Francesco Romeo
(13)
,
Mauro Rinaldi
(1)
,
Gaetano Maria de Ferrari
(1)
,
Gerard Helft
(25)
1
Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
2 Nippon Medical School [Tokyo, Japon]
3 University hospital of Zurich [Zurich]
4 CH2SA - Civil Hospital SS. Annunziata [Savigliano, Italy]
5 Centro Cardiologico Monzino [Milano]
6 UNIMI - Università degli Studi di Milano = University of Milan
7 OSGB - Ospedale San Giovanni Bosco [Turin, Italy]
8 Hospital Clínico San Carlos [Madrid, Spain]
9 OR - Ospedale di Rivoli [Rivoli, Italy]
10 SLGUH Orbassano - San Luigi Gonzaga University Hospital [Turin, Italy]
11 AOU Policlinico Vittorio-Emanuele [Catania, Italia]
12 San Raffaele Scientific Institute
13 Università degli Studi di Roma Tor Vergata [Roma] = University of Rome Tor Vergata
14 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
15 SUM - Medical University of Silesia
16 University Hospital “Maggiore della Carità” [Novara, Italy]
17 Polito - Politecnico di Torino = Polytechnic of Turin
18 Royal Brompton Hospital
19 Royal Brompton and Harefield NHS Foundation Trust
20 Imperial College London
21 UW - University of Warsaw
22 OSGE - Ospedale San Giovanni Evangelista [Rome, Italy]
23 CP - Clinica Pederzoli [Peschiera del Garda, Italy]
24 ASST Fatebenefratelli-Sacco [Milan, Italy]
25 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
2 Nippon Medical School [Tokyo, Japon]
3 University hospital of Zurich [Zurich]
4 CH2SA - Civil Hospital SS. Annunziata [Savigliano, Italy]
5 Centro Cardiologico Monzino [Milano]
6 UNIMI - Università degli Studi di Milano = University of Milan
7 OSGB - Ospedale San Giovanni Bosco [Turin, Italy]
8 Hospital Clínico San Carlos [Madrid, Spain]
9 OR - Ospedale di Rivoli [Rivoli, Italy]
10 SLGUH Orbassano - San Luigi Gonzaga University Hospital [Turin, Italy]
11 AOU Policlinico Vittorio-Emanuele [Catania, Italia]
12 San Raffaele Scientific Institute
13 Università degli Studi di Roma Tor Vergata [Roma] = University of Rome Tor Vergata
14 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
15 SUM - Medical University of Silesia
16 University Hospital “Maggiore della Carità” [Novara, Italy]
17 Polito - Politecnico di Torino = Polytechnic of Turin
18 Royal Brompton Hospital
19 Royal Brompton and Harefield NHS Foundation Trust
20 Imperial College London
21 UW - University of Warsaw
22 OSGE - Ospedale San Giovanni Evangelista [Rome, Italy]
23 CP - Clinica Pederzoli [Peschiera del Garda, Italy]
24 ASST Fatebenefratelli-Sacco [Milan, Italy]
25 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
Fabrizio d'Ascenzo
- Fonction : Auteur
- PersonId : 785116
- ORCID : 0000-0002-6646-9317
Mohamed Abdirashid
- Fonction : Auteur
- PersonId : 1222780
- ORCID : 0000-0003-2287-2988
Nicola Ryan
- Fonction : Auteur
- PersonId : 1222781
- ORCID : 0000-0002-2451-8790
Giuseppe Venuti
- Fonction : Auteur
- PersonId : 1222758
- ORCID : 0000-0003-3486-1039
Diego Gallo
- Fonction : Auteur
- PersonId : 1222782
- ORCID : 0000-0002-7409-7111
Leonardo de Luca
- Fonction : Auteur
- PersonId : 1222783
- ORCID : 0000-0002-8552-1272
Alessio Mattesini
- Fonction : Auteur
- PersonId : 1222784
- ORCID : 0000-0001-8697-2692
Bernardo Cortese
- Fonction : Auteur
- PersonId : 1222763
- ORCID : 0000-0002-5808-7810
Umberto Morbiducci
- Fonction : Auteur
- PersonId : 1222785
- ORCID : 0000-0002-9854-1619
Mario Iannaccone
- Fonction : Auteur
- PersonId : 1222786
- ORCID : 0000-0003-0571-3918
Résumé
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.