Timing of Bleeding and Ischemic Events in High-Bleeding Risk Patients Treated With 1-Month DAPT.

BACKGROUND: Understanding the concomitant evolution of bleeding vs ischemic risk after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) treated with 1-month dual antiplatelet therapy (DAPT) would help optimize dynamic treatment strategies. OBJECTIVES: The aim of this study was to describe the timing of bleeding and ischemic events during 1 year after PCI in this population. METHODS: Timings of major bleeding events and of major adverse cardiovascular events (MACE) were analyzed in patient-level data from 7 prospective studies including HBR patients treated with PCI and 1-month DAPT. RESULTS: Among 7,266 patients (mean age 76 ± 9.0 years, 31.5% women), Bleeding Academic Research Consortium (BARC) types 3 to 5 bleeding occurred in 284 (4.0%), with 73 (1.0%) occurring ≤30 days after and 211 (2.9%) >30 days after index PCI. MACE occurred in 433 patients (6.0%), among which 64 (0.9%) occurred ≤30 days after index PCI and 369 (5.1%) after 30 days. During the first 30 days, there was no significant difference between rates of MACE and BARC types 3 to 5 bleeding events (22.3% vs 25.7%; P = 0.407). However, MACE rates were significantly higher than rates of BARC types 3 to 5 bleeding between 31 and 90 days (7.2% vs 4.9%; P = 0.024) and between 91 and 365 days (5.3% vs 3.1%; P < 0.001) CONCLUSIONS: Among HBR patients undergoing PCI treated with 1-month DAPT, the risk for major bleeding and MACE is highest in the first 30 days. MACE remain consistently more frequent than bleeding after the first month, when event rates stabilize over time while on single antiplatelet therapy.

Duke Scholars

Author Mitchell Wolfe Krucoff Medicine, Cardiology