Duration of dual antiplatelet therapy in elective drug-coated balloon angioplasty
Duration of dual antiplatelet therapy in elective drug-coated balloon angioplasty
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DOI：
10.1002/ccd.28632
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发表时间：
2019-12-04
影响因子：
2.3
通讯作者：
Eccleshall, Simon C.
中科院分区：
文献类型：
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作者：
Corballis, Natasha H.;Wickramarachchi, Upul;Eccleshall, Simon C.
目的：我们试图回答选择性药物涂层球囊（DCB）血管成形术后1个月的双重抗血小板治疗（DAPT）是否安全。背景在2017年ESC重点DAPT更新后，择期DCB后DAPT的持续时间受到质疑。在此之前，由前瞻性全球登记研究数据支持的国家共识小组（德国、意大利和中国）认为1个月的DAPT是安全的。ESC指南仅基于支架内再狭窄随机对照试验的证据建议DAPT持续6个月。方法回顾性、真实世界人群、单中心分析，于2012年1月1日至2017年3月31日在一家高容量三级PCI中心进行。入选了择期DCB血管成形术后接受1个月DAPT的连续患者。我们确定了6个月时心脏性死亡、心肌梗死和靶病变血运重建的主要复合结局。结果共纳入303例患者（78.5%为男性），平均年龄为67 ± 12.5岁。其中包括86.1%的原发病变和56.5%的接受治疗的非小（直径>= 3 mm）冠状动脉。6个月时未报告病变血栓形成、靶血管MI、靶病变血运重建或心源性死亡的结局。有2例（0.6%）非靶血管MI和1例（0.3%）非心源性死亡。结论：在选择性仅DCB血管成形术后，1个月的DAPT似乎是安全的，强调了这种策略对高出血风险患者的作用。这些结果也显示了仅采用DCB血管成形术治疗的原发冠状动脉疾病和非小冠状动脉的良好临床结局。为期1个月的DAPT似乎是一个安全和有吸引力的选择。
Objectives We sought to answer whether 1-month duration of dual antiplatelet therapy (DAPT) is safe after elective drug-coated balloon only (DCB) angioplasty. Background The duration of DAPT after elective DCB was called into question after the ESC Focused DAPT Update of 2017. Until then, a 1-month duration of DAPT was considered safe by national consensus groups (German, Italian, and Chinese) supported by data from prospective worldwide registries. The ESC Guidelines recommended a 6-month duration of DAPT based on evidence from in-stent restenosis randomized controlled trials only. Methods Retrospective, real-world population, single-center analysis conducted from January 1, 2012 to March 31, 2017 in a high-volume, tertiary PCI center. Consecutive patients receiving 1-month duration of DAPT after elective DCB angioplasty were included. We identified a primary composite outcome of cardiac death, myocardial infarction and target lesion revascularization at 6-months. Results A total of 303 patients (78.5% male) with mean age of 67 +/- 12.5 were included. This incorporated 86.1% de novo lesions and 56.5% nonsmall (>= 3 mm diameter) coronary arteries treated. There were no reported outcomes of lesion thrombosis, target vessel MI, target lesion revascularization or cardiac death at 6-months. There were two (0.6%) nontarget vessel MIs and one (0.3%) noncardiac death. Conclusion One-month duration of DAPT appears safe after elective DCB-only angioplasty, highlighting this strategy for patients at high-risk of bleeding. These results also show favorable clinical outcomes for de novo coronary artery disease and nonsmall coronary arteries treated with DCB-only angioplasty. A 1-month duration of DAPT appears a safe and attractive option.