TY - JOUR
T1 - Short-Term DAPT After Complex PCI With Third-Generation DES
T2 - A Post Hoc Analysis of the HOST-IDEA Trial
AU - Han, Jung Kyu
AU - Lee, Keehwan
AU - Park, Sang Hyeon
AU - Yang, Seokhun
AU - Hwang, Doyeon
AU - Kang, Jeehoon
AU - Yang, Han Mo
AU - Park, Kyung Woo
AU - Kang, Hyun Jae
AU - Koo, Bon Kwon
AU - Hur, Seung Ho
AU - Kim, Weon
AU - Park, Sang Hyun
AU - Han, Seung Hwan
AU - Kim, Sang Hyun
AU - Kim, Yong Hoon
AU - Lee, Namho
AU - Lee, Seung Jin
AU - Shin, Sanghoon
AU - Kim, Hyo Soo
N1 - Publisher Copyright:
© 2025 American Heart Association, Inc.
PY - 2025/5/1
Y1 - 2025/5/1
N2 - BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of DAPT 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 DAPT 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 DAPT was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month DAPT. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.
AB - BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of DAPT 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 DAPT 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 DAPT was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month DAPT. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02601157.
KW - coronary artery disease
KW - drug-eluting stents
KW - percutaneous coronary intervention
KW - risk
UR - https://www.scopus.com/pages/publications/105002046374
U2 - 10.1161/CIRCINTERVENTIONS.124.014623
DO - 10.1161/CIRCINTERVENTIONS.124.014623
M3 - Article
C2 - 40160090
AN - SCOPUS:105002046374
SN - 1941-7640
VL - 18
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 5
M1 - e014623
ER -