Personalized or Standard Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: The PARTHENOPE Randomized Trial.

IF 22.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Raffaele Piccolo, Paolo Calabrò, Greta Carrara, Fiorenzo Simonetti, Attilio Varricchio, Tiziana Attisano, Giovanni Napolitano, Ciro De Simone, Gerardo Carpinella, Eugenio Stabile, Plinio Cirillo, Luigi Di Serafino, Gianluca Caiazzo, Tullio Tesorio, Marco Boccalatte, Bernardino Tuccillo, Marisa Avvedimento, Attilio Leone, Gennaro Galasso, Arturo Cesaro, Rocco Perrotta, Tullio Niglio, Domenico Simone Castiello, Maddalena Immobile Molaro, Luca Bardi, Alessandra Spinelli, Stefano Cristiano, Michele Bellino, Sergio Leonardi, Simone Biscaglia, Francesco Costa, Salvatore Cassese, Eugene McFadden, Dik Heg, Giulio G Stefanini, Anna Franzone, Davide Capodanno, Giovanni Esposito
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引用次数: 0

Abstract

Background: Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain.

Objectives: The authors performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3, 6, or 24 months with a standard duration of DAPT for 12 months after PCI.

Methods: We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary endpoint was a net adverse clinical event (NACE) at 24 months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium criteria.

Results: At 24 months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points; 95% CI: -6.99 to -0.99; P = 0.040). This difference was mainly related to decreased rates of myocardial infarction (difference, -2.29 percentage points; 95% CI: -4.43 to -0.14) and urgent target vessel revascularization (difference, -1.30 percentage points; 95% CI: -2.55 to -0.05). Bleeding occurred at similar rates between the 2 groups (difference, -0.41 percentage points; 95% CI: -2.92 to 2.10).

Conclusions: In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of NACE than standard care consisting of 12 months of DAPT. (Personalized Vs. Standard Duration of Dual Antiplatelet Therapy and New-generation Polymer-Free vs- Biodegradable-Polymer DES [PARTHENOPE]; NCT04135989).

经皮冠状动脉介入治疗后双重抗血小板治疗的个性化或标准持续时间:PARTHENOPE随机试验。
背景:双重抗血小板治疗(DAPT)被推荐用于经皮冠状动脉介入治疗(PCI)的患者,尽管其最佳持续时间尚不确定。目的:我们进行了一项随机试验,比较基于风险评分的个人化DAPT持续时间为3、6或24个月与PCI术后标准DAPT持续时间为12个月。方法:我们随机分配2107例接受PCI的患者接受个性化或标准DAPT。主要终点是24个月时的净不良临床终点(NACE),定义为根据出血学术研究联盟(BARC)标准的全因死亡、心肌梗死、卒中、紧急靶血管重建或2型、3型或5型出血的综合。结果:24个月时,个体化DAPT组1055例患者中有196例(18.6%)发生NACE,标准DAPT组1052例患者中有232例(22.2%)发生NACE(差异3.54个百分点,95%可信区间[CI], -6.99至-0.99;P=0.040)。这一差异主要与心肌梗死发生率降低(差异,-2.29个百分点,95% CI, -4.43至-0.14)和紧急靶血管重建术(差异,-1.30个百分点,95% CI, -2.55至-0.05)有关。两组之间出血发生率相似(差异为-0.41个百分点;95%可信区间[CI], -2.92至2.10)。结论:在接受PCI的患者中,基于临床风险评分的个性化DAPT持续时间为3至24个月,导致净不良临床事件的风险低于由12个月DAPT组成的标准治疗。
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来源期刊
CiteScore
42.70
自引率
3.30%
发文量
5097
审稿时长
2-4 weeks
期刊介绍: The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints. Content Profile: -Original Investigations -JACC State-of-the-Art Reviews -JACC Review Topics of the Week -Guidelines & Clinical Documents -JACC Guideline Comparisons -JACC Scientific Expert Panels -Cardiovascular Medicine & Society -Editorial Comments (accompanying every Original Investigation) -Research Letters -Fellows-in-Training/Early Career Professional Pages -Editor’s Pages from the Editor-in-Chief or other invited thought leaders
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