Antiaggregation Time after Treating Bifurcations

Defining dual antiplatelet therapy (DAPT) seems a never-ending story. We go from trials showing the safety of shorter schemes thanks to new generation stents to others suggesting up to two years of DAPT. Rather than finding a general scheme, it seems to be about adjusting DAPT on a case by case basis, according to ischemia and thrombosis risk-benefit ratio.  On this note, more and more evidence supports the idea that complex PCI procedures benefit from prolonged DAPT, and bifurcations qualify as complex.

This study included 2082 patients receiving drug eluting stents (DES) to treat bifurcation lesions who were event free (death, infarction, stoke, stent thrombosis or any revascularization) for 12 months after index procedure. Patients were divided in two groups: those receiving <12 months DAPT and those receiving over 12 months.

At 4 year follow up, patients with over 12 months of DAPT presented less events (death or infarction) than those with less than a year of DAPT (2.8% vs. 12.3%; HR 0.21; CI 95% 0.13–0.35; p<0.001).

Read also: ESC 2018 | GLOBAL LEADERS: Ticagrelor Monotherapy Is Not Superior to Classic Therapies After Angioplasty.

This difference remained significant after propensity score matching and was consistent regardless lesion location, stenting technique, or kind of DES.

Conclusion

The risk of all cause mortality and acute myocardial infarction was significantly lower in patients receiving over 12 months DAPT after bifurcation DES stenting. These outcomes suggest prolonged DAPT could improve clinical outcomes in this subgroup of patients.

Original title: Benefit of Prolonged Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stent for Coronary Bifurcation Lesions. Results from the Coronary Bifurcation Stenting Registry II.

Reference: Woo Jin Jang et al. Circ Cardiovasc Interv. 2018;11:e005849.

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