An Abbreviated Dual Antiplatelet Regimen Is Also Safe in Patients at High Risk for Bleeding Undergoing Complex Angioplasty

The MASTER DAPT study analyzed the results of an abbreviated (mean 34 days) vs. conventional dual antiplatelet therapy (DAPT) in 4579 patients treated with angioplasty and a biodegradable polymer sirolimus-eluting stent.

This recent publication on the same study analyzed the evolution within the same strategies of the subgroup of patients with complex angioplasty and compared it with the subgroup of non-complex angioplasty.

“Complex” was defined as any angioplasty procedure done in the three major epicardial vessels, chronic occlusions, stent over 60 mm, more than three stents, bifurcation lesions, or treatment of more than three lesions.

As in the global study, researchers analyzed overall adverse events (NACE; a composite of overall mortality, infarction, stroke, or BARC 3 or 5 bleeding) and ischemic events (MACCE; overall mortality, infarction, or stroke), in both groups, using noninferiority criteria; bleeding events (BARC 2, 3, or 5 bleeding) were analyzed using superiority criteria.

NACE and MACCE were similar between the abbreviated vs. conventional DAPT regimes in patients who underwent complex angioplasty (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively) and non-complex angioplasty (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; p interaction = 0.60 and 0.26, respectively). BARC type 2, 3, or 5 bleeding decreased with abbreviated DAPT in both subgroups (complex and non-complex angioplasty) (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55- 0.89; p interaction = 0.72).

Read also: ESC 2021 | MASTER DAPT: Dual Antiplatelet Therapy After Coronary Angioplasty in Patients at High Bleeding Risk.

The authors conclude that only one month of DAPT in this group of patients treated with Ultimaster/Tansei stents does not increase the incidence of total adverse events or ischemic events, and it decreases bleeding events independently of angioplasty complexity.

Dr. José Álvarez.
Web Area Director and Editorial Board of SOLACI.org.

Original Title: Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis. 

Reference: European Heart Journal (2022) 00, 1–15 https://doi.org/10.1093/eurheartj/ehac284. 

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