Jung-Kyu Han, Keehwan Lee, Sang-Hyeon Park, Seokhun Yang, Doyeon Hwang, Jeehoon Kang, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, Seung-Ho Hur, Weon Kim, Sang-Hyun Park, Seung Hwan Han, Sang-Hyun Kim, Yong Hoon Kim, Namho Lee, Seung Jin Lee, Sanghoon Shin, Hyo-Soo Kim
{"title":"采用第三代DES的复杂PCI术后短期DAPT: HOST-IDEA试验的事后分析。","authors":"Jung-Kyu Han, Keehwan Lee, Sang-Hyeon Park, Seokhun Yang, Doyeon Hwang, Jeehoon Kang, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, Seung-Ho Hur, Weon Kim, Sang-Hyun Park, Seung Hwan Han, Sang-Hyun Kim, Yong Hoon Kim, Namho Lee, Seung Jin Lee, Sanghoon Shin, Hyo-Soo Kim","doi":"10.1161/CIRCINTERVENTIONS.124.014623","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The optimal duration of dual antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of dual antiplatelet therapy over 12 months after complex PCI.</p><p><strong>Methods: </strong>A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months.</p><p><strong>Results: </strong>Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened dual antiplatelet therapy duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403-1.659) for the complex PCI group and 1.282 (95% CI, 0.506-3.249) for the noncomplex PCI group (<i>P</i><sub>interaction</sub>=0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075-0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627-3.754], showing a significant interaction; <i>P</i><sub>interaction</sub>=0.029).</p><p><strong>Conclusions: </strong>In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of dual antiplatelet therapy was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month dual antiplatelet therapy.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014623"},"PeriodicalIF":6.1000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial.\",\"authors\":\"Jung-Kyu Han, Keehwan Lee, Sang-Hyeon Park, Seokhun Yang, Doyeon Hwang, Jeehoon Kang, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, Seung-Ho Hur, Weon Kim, Sang-Hyun Park, Seung Hwan Han, Sang-Hyun Kim, Yong Hoon Kim, Namho Lee, Seung Jin Lee, Sanghoon Shin, Hyo-Soo Kim\",\"doi\":\"10.1161/CIRCINTERVENTIONS.124.014623\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The optimal duration of dual antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of dual antiplatelet therapy over 12 months after complex PCI.</p><p><strong>Methods: </strong>A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months.</p><p><strong>Results: </strong>Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened dual antiplatelet therapy duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403-1.659) for the complex PCI group and 1.282 (95% CI, 0.506-3.249) for the noncomplex PCI group (<i>P</i><sub>interaction</sub>=0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075-0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627-3.754], showing a significant interaction; <i>P</i><sub>interaction</sub>=0.029).</p><p><strong>Conclusions: </strong>In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of dual antiplatelet therapy was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month dual antiplatelet therapy.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"e014623\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014623\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014623","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial.
Background: The optimal duration of dual antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of dual antiplatelet therapy over 12 months after complex PCI.
Methods: A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months.
Results: Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened dual antiplatelet therapy duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403-1.659) for the complex PCI group and 1.282 (95% CI, 0.506-3.249) for the noncomplex PCI group (Pinteraction=0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075-0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627-3.754], showing a significant interaction; Pinteraction=0.029).
Conclusions: In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of dual antiplatelet therapy was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month dual antiplatelet therapy.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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