30-Day DAPT in Patients at High Bleeding Risk Undergoing PCI With Biodegradable-Polymer Sirolimus-Eluting Ultra-Thin...

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomaterials Science

Background:

• Limited evidence exists on biodegradable-polymer sirolimus-eluting stent (BP-SES) safety and efficacy in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI).
• Optimizing antiplatelet therapy duration is crucial for HBR patients to balance ischemic and bleeding risks.

Purpose of the Study:

• To evaluate the clinical outcomes of HBR patients treated with BP-SES and a short dual antiplatelet therapy (DAPT) regimen (≤30 days).
• To assess the safety and efficacy of a ≤30-day DAPT regimen in HBR patients undergoing PCI with BP-SES.

Main Methods:

• A systematic review and individual patient-level data extraction were performed.
• Included studies focused on HBR patients treated with BP-SES (Supraflex Cruz) via PCI.
• Primary endpoint: composite of cardiovascular death, myocardial infarction, or target lesion revascularization at 1 year. Safety endpoint: Bleeding Academic Research Consortium (BARC) type 3-5 bleeding at 1 year.

Main Results:

• 1691 HBR patients were analyzed; 928 (55%) received ≤30-day DAPT.
• The ≤30-day DAPT group showed a 1-year primary outcome event rate of 9.5% (95% CI: 7.7%-11.6%), below the non-inferiority margin of 14%.
• No significant difference in primary outcomes between ≤30-day and >30-day DAPT groups; notably, BARC 3-5 bleeding events were significantly lower in the ≤30-day DAPT group.

Conclusions:

• A ≤30-day DAPT regimen is associated with a low rate of ischemic events in HBR patients treated with BP-SES.
• This short DAPT duration significantly reduces major bleeding events in this patient population.
• The findings support the use of shorter DAPT durations in HBR patients undergoing PCI with BP-SES.