One- Versus Three-Month DAPT in Older Patients at High Bleeding Risk Undergoing PCI: Insights From the XIENCE Short DAPT Global Program.

Sardella, Gennaro; Spirito, Alessandro; Sartori, Samantha; Angiolillo, Dominick J; Vranckx, Pascal; De la Torre Hernandez, Jose M; Krucoff, Mitchell W; Bangalore, Sripal; Bhatt, Deepak L; Campo, Gianluca; Cao, Davide; Chehab, Bassem M; Choi, James W; Feng, Yihan; Ge, Junbo; Godfrey, Katherine; Hermiller, James; Kunadian, Vijay; Makkar, Raj R; Maksoud, Aziz; ... (2024). One- Versus Three-Month DAPT in Older Patients at High Bleeding Risk Undergoing PCI: Insights From the XIENCE Short DAPT Global Program. The American journal of cardiology, 214, pp. 94-104. Elsevier 10.1016/j.amjcard.2023.12.049

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This analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from three prospective, single-arm studies (XIENCE Short DAPT Program), including high bleeding risk (HBR) patients successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and <75 years). The primary endpoint was all-cause death or myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2-5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. Out of 3,364 patients, 2,241 (66.6%) were ≥75 years old. The risk of death or MI was similar with 1- vs 3-month DAPT in patients ≥75 (8.5% vs 8.0%, adjusted HR 0.95, 95% CI 0.69-1.30) and <75 years old (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60-1.57; interaction p-value 0.478). BARC type 2-5 bleeding was consistently lower with 1- than with 3-month DAPT in patients ≥75 years old (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48-0.91) and <75 years old (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57-1.29; interaction p-value 0.737). In conclusion, among HBR patients undergoing PCI, patients older and younger than 75 years of age derived a consistent benefit from 1- as compared with 3-month DAPT in terms of bleeding reduction with no increase in all-cause death or MI at 1 year.

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