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Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial
Jung-Kyu Han1,2, Keehwan Lee1,3, Sang-Hyeon Park1,4
1Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., K.L., Sang-Hyeon Park, S.Y., D.H., J.K., H.-M.Y., K.W.P., H.-J.K., B.-K.K., H.-S.K.).
Insights
Shortened dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI) reduces bleeding risk without increasing ischemic events. This finding supports a 3- to 6-month DAPT duration for patients with complex PCI using drug-eluting stents.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The optimal duration of dual antiplatelet therapy (DAPT) following complex percutaneous coronary intervention (PCI) is not well-established.
- Complex PCI involves procedures like multiple stent implantations, extensive lesion treatment, or left main interventions.
- Patients undergoing complex PCI often present with higher bleeding risks, necessitating careful consideration of DAPT duration.
Purpose of the Study:
- To evaluate the efficacy and safety of a shortened DAPT duration (3-6 months) compared to a standard 12-month duration after complex PCI.
- To determine if a shorter DAPT regimen impacts the risk of ischemic events (target lesion failure) and bleeding events (major bleeding).
Main Methods:
- A post hoc analysis of the HOST-IDEA randomized trial involving patients treated with third-generation drug-eluting stents.
- Complex PCI was defined by specific procedural criteria including number of stents, lesions treated, stent length, and anatomical complexity.
- Primary endpoints included target lesion failure (cardiac death, MI, revascularization) and major bleeding (BARC type 3 or 5) at 12 months.
Main Results:
- In the complex PCI subgroup (n=624), a 3- to 6-month DAPT duration did not increase the risk of target lesion failure (HR 0.818).
- Shortened DAPT significantly reduced the risk of major bleeding in the complex PCI group (HR 0.269, Pinteraction=0.029).
- No significant increase in ischemic events or significant reduction in bleeding was observed in the non-complex PCI group with shortened DAPT.
Conclusions:
- A 3- to 6-month DAPT duration is safe and effective for patients undergoing complex PCI with third-generation drug-eluting stents.
- Shortening DAPT in this population reduces bleeding complications without compromising ischemic outcomes.
- These findings provide evidence for tailoring DAPT duration based on PCI complexity.
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.
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