Recurrent Events Analysis of MASTER DAPT: Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in HBR Patients

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F65269705%3A_____%2F25%3A00082161" target="_blank" >RIV/65269705:_____/25:00082161 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216224:14110/25:00142482

Výsledek na webu

<a href="https://www.sciencedirect.com/science/article/pii/S0735109725064836" target="_blank" >https://www.sciencedirect.com/science/article/pii/S0735109725064836</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.jacc.2025.05.010" target="_blank" >10.1016/j.jacc.2025.05.010</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Recurrent Events Analysis of MASTER DAPT: Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in HBR Patients

Popis výsledku v původním jazyce

BACKGROUND: The effect of dual antiplatelet therapy (DAPT) duration on total events in patients at high bleeding risk (HBR) after percutaneous coronary intervention (PCI) is unclear. OBJECTIVES: This study aimed to evaluate an abbreviated (median duration, 34 days) vs prolonged (median duration, 192 days) DAPT regimen on total events in 4,579 HBR patients from the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen) trial. METHODS: The MASTER DAPT coprimary outcomes at 335 days were as follows: 1) net adverse clinical events (NACEs), the composite of all-cause death, myocardial infarction (MI), stroke, and Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding events; 2) major adverse cardiac and cerebral events (MACCEs), including all-cause death, MI, and stroke; and 3) major or clinically relevant nonmajor bleeding (MCB, type 2, 3, or 5 BARC bleeding). The differences between abbreviated and prolonged DAPT regimens were investigated using the Prentice, Williams, and Peterson model to account for recurrent events. Additional analyses were performed using the Andersen-Gill and Poisson incidence rate models. RESULTS: In the abbreviated DAPT (n = 2,295) arm of the trial, 214 NACEs occurred in 172 patients, compared with 227 NACEs in 182 patients in the prolonged DAPT arm (n = 2,284; HR: 0.95; 95% CI: 0.78-1.16; P = 0.64). A total of 156 MACCEs in 138 patients were observed in the abbreviated DAPT group compared with 160 MACCEs in 138 patients in the prolonged DAPT arm (HR: 0.96; 95% CI: 0.76-1.20; P = 0.69). Fewer total MCBs were observed in the abbreviated DAPT group (180 MCBs in 148 patients) compared with the prolonged DAPT group (240 MCBs in 211 patients, HR: 0.78; 95% CI: 0.64-0.94; P = 0.011). Abbreviated DAPT patients had significantly fewer total cerebrovascular accidents and fewer total strokes compared with the prolonged DAPT group (34 events in 32 patients, HR: 0.51; 95% CI: 0.28-0.91; P = 0.023; and 25 events in 24 patients, HR: 0.49; 95% CI: 0.25-0.98; P = 0.04, respectively). One MACCE in every 5 occurred after a bleeding event, and 1 bleeding event in every 25 occurred after a MACCE, thus emphasizing bleeding as a sentinel event. CONCLUSIONS: A 1-month DAPT duration was associated with similar total NACEs and MACCEs and reduced total bleeding risk compared with prolonged DAPT. Providing a more comprehensive assessment of the total clinical burden, these findings support the use of an abbreviated duration of DAPT after PCI in HBR patients. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen [MASTER DAPT]; NCT03023020).

Název v anglickém jazyce

Recurrent Events Analysis of MASTER DAPT: Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in HBR Patients

Popis výsledku anglicky

BACKGROUND: The effect of dual antiplatelet therapy (DAPT) duration on total events in patients at high bleeding risk (HBR) after percutaneous coronary intervention (PCI) is unclear. OBJECTIVES: This study aimed to evaluate an abbreviated (median duration, 34 days) vs prolonged (median duration, 192 days) DAPT regimen on total events in 4,579 HBR patients from the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen) trial. METHODS: The MASTER DAPT coprimary outcomes at 335 days were as follows: 1) net adverse clinical events (NACEs), the composite of all-cause death, myocardial infarction (MI), stroke, and Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding events; 2) major adverse cardiac and cerebral events (MACCEs), including all-cause death, MI, and stroke; and 3) major or clinically relevant nonmajor bleeding (MCB, type 2, 3, or 5 BARC bleeding). The differences between abbreviated and prolonged DAPT regimens were investigated using the Prentice, Williams, and Peterson model to account for recurrent events. Additional analyses were performed using the Andersen-Gill and Poisson incidence rate models. RESULTS: In the abbreviated DAPT (n = 2,295) arm of the trial, 214 NACEs occurred in 172 patients, compared with 227 NACEs in 182 patients in the prolonged DAPT arm (n = 2,284; HR: 0.95; 95% CI: 0.78-1.16; P = 0.64). A total of 156 MACCEs in 138 patients were observed in the abbreviated DAPT group compared with 160 MACCEs in 138 patients in the prolonged DAPT arm (HR: 0.96; 95% CI: 0.76-1.20; P = 0.69). Fewer total MCBs were observed in the abbreviated DAPT group (180 MCBs in 148 patients) compared with the prolonged DAPT group (240 MCBs in 211 patients, HR: 0.78; 95% CI: 0.64-0.94; P = 0.011). Abbreviated DAPT patients had significantly fewer total cerebrovascular accidents and fewer total strokes compared with the prolonged DAPT group (34 events in 32 patients, HR: 0.51; 95% CI: 0.28-0.91; P = 0.023; and 25 events in 24 patients, HR: 0.49; 95% CI: 0.25-0.98; P = 0.04, respectively). One MACCE in every 5 occurred after a bleeding event, and 1 bleeding event in every 25 occurred after a MACCE, thus emphasizing bleeding as a sentinel event. CONCLUSIONS: A 1-month DAPT duration was associated with similar total NACEs and MACCEs and reduced total bleeding risk compared with prolonged DAPT. Providing a more comprehensive assessment of the total clinical burden, these findings support the use of an abbreviated duration of DAPT after PCI in HBR patients. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen [MASTER DAPT]; NCT03023020).

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Journal of the American College of Cardiology

ISSN

0735-1097

e-ISSN

1558-3597

Svazek periodika

86

Číslo periodika v rámci svazku

7

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

14

Strana od-do

485-498

Kód UT WoS článku

001583423400012

EID výsledku v databázi Scopus

2-s2.0-105008560355