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).
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