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Title: | Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk | Authors: | Smits, Pieter C. Frigoli, Enrico VRANCKX, Pascal Ozaki, Yukio Morice, Marie -Claude Chevalier, Bernard Onuma, Yoshinobu Windecker, Stephan Tonino, Pim A. L. Roffi, Marco Lesiak, Maciej Mahfoud, Felix Bartunek, Jozef Hildick-Smith, David Colombo, Antonio Stankovic, Goran Iniguez, Andres Schultz, Carl Kornowski, Ran Ong, Paul J. L. Alasnag, Mirvat Rodriguez, Alfredo E. Paradies, Valeria Kala, Petr Kedev, Sasko Al Mafragi, Amar Dewilde, Willem Heg, Dik Valgimigli, Marco MASTER DAPT Investigators |
Issue Date: | 2022 | Publisher: | ELSEVIER SCIENCE INC | Source: | JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 80 (13) , p. 1220 -1237 | Abstract: | BACKGROUND The optimal duration of antiplatelet therapy (APT) after coronary stenting in patients at high bleeding risk (HBR) presenting with an acute coronary syndrome remains unclear.OBJECTIVES The objective of this study was to investigate the safety and efficacy of an abbreviated APT regimen after coronary stenting in an HBR population presenting with acute or recent myocardial infarction.METHODS In the MASTER DAPT trial, 4,579 patients at HBR were randomized after 1 month of dual APT (DAPT) to abbreviated (DAPT stopped and 11 months single APT or 5 months in patients with oral anticoagulants) or nonabbreviated APT (DAPT for minimum 3 months) strategies. Randomization was stratified by acute or recent myocardial infarction at index procedure. Coprimary outcomes at 335 days after randomization were net adverse clinical outcomes events (NACE); major adverse cardiac and cerebral events (MACCE); and type 2, 3, or 5 Bleeding Academic Research Consortium bleeding.RESULTS NACE and MACCE did not differ with abbreviated vs nonabbreviated APT regimens in patients with an acute or recent myocardial infarction (n =1,780; HR: 0.83; 95% CI: 0.61-1.12 and HR: 0.86; 95% CI: 0.62-1.19, respectively) or without an acute or recent myocardial infarction (n = 2,799; HR: 1.03; 95% CI: 0.77-1.38 and HR: 1.13; 95% CI: 0.80-1.59; Pinteraction = 0.31 and 0.25, respectively). Bleeding Academic Research Consortium 2, 3, or 5 bleeding was signifi-cantly reduced in patients with or without an acute or recent myocardial infarction (HR: 0.65; 95% CI: 0.46-0.91 and HR: 0.71; 95% CI: 0.54-0.92; Pinteraction = 0.72) with abbreviated APT.CONCLUSIONS A 1-month DAPT strategy in patients with HBR presenting with an acute or recent myocardial infarction results in similar NACE and MACCE rates and reduces bleedings compared with a nonabbreviated DAPT strategy. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020) (J Am Coll Cardiol 2022;80:1220-1237) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). | Notes: | Smits, PC (corresponding author), Maasstad Zie kenhuis, Dept Cardiol, Maasstadweg 21, NL-3079 DZ Rotterdam, Netherlands. SmitsP@maasstadziekenhuis.nl |
Keywords: | acute coronary syndrome;antiplatelet therapy;dual antiplatelet therapy;percutaneous coronary intervention | Document URI: | http://hdl.handle.net/1942/38908 | ISSN: | 0735-1097 | e-ISSN: | 1558-3597 | DOI: | 10.1016/j.jacc.2022.07.016 | ISI #: | 000875244600004 | Rights: | 2022 THE AUTHORS. PUBLISHED BY ELSEVIER ON BEHALF OF THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION. THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY-NC-ND LICENSE ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) . | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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