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2. Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Author

Palmerini, Tullio, primary, Bacchi Reggiani, Letizia, additional, Della Riva, Diego, additional, Romanello, Mattia, additional, Feres, Fausto, additional, Abizaid, Alexandre, additional, Gilard, Martine, additional, Morice, Marie-Claude, additional, Valgimigli, Marco, additional, Hong, Myeong-Ki, additional, Kim, Byeong-Keuk, additional, Jang, Yangsoo, additional, Kim, Hyo-Soo, additional, Park, Kyung Woo, additional, Colombo, Antonio, additional, Chieffo, Alaide, additional, Ahn, Jung-Min, additional, Park, Seung-Jung, additional, Schüpke, Stefanie, additional, Kastrati, Adnan, additional, Montalescot, Gilles, additional, Steg, Philippe Gabriel, additional, Diallo, Abdourahmane, additional, Vicaut, Eric, additional, Helft, Gerard, additional, Biondi-Zoccai, Giuseppe, additional, Xu, Bo, additional, Han, Yaling, additional, Genereux, Philippe, additional, Bhatt, Deepak L., additional, and Stone, Gregg W., additional

Published
2017
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3. Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Author

Abdourahmane Diallo, Bo Xu, Giuseppe Biondi-Zoccai, Seung-Jung Park, Jung-Min Ahn, Philippe Généreux, Gregg W. Stone, Yaling Han, Gilles Montalescot, Hyo-Soo Kim, Stefanie Schüpke, Diego Della Riva, Alexandre Abizaid, Deepak L. Bhatt, Adnan Kastrati, Philippe Gabriel Steg, Martine Gilard, Letizia Bacchi Reggiani, Marco Valgimigli, Yangsoo Jang, Marie Claude Morice, Tullio Palmerini, Myeong Ki Hong, Mattia Romanello, Eric Vicaut, Alaide Chieffo, Gérard Helft, Antonio Colombo, Byeong Keuk Kim, Kyung Woo Park, Fausto Feres, Palmerini, Tullio, Bacchi Reggiani, Letizia, Della Riva, Diego, Romanello, Mattia, Feres, Fausto, Abizaid, Alexandre, Gilard, Martine, Morice, Marie-Claude, Valgimigli, Marco, Hong, Myeong-Ki, Kim, Byeong-Keuk, Jang, Yangsoo, Kim, Hyo-Soo, Park, Kyung Woo, Colombo, Antonio, Chieffo, Alaide, Ahn, Jung-Min, Park, Seung-Jung, Schüpke, Stefanie, Kastrati, Adnan, Montalescot, Gille, Steg, Philippe Gabriel, Diallo, Abdourahmane, Vicaut, Eric, Helft, Gerard, Biondi-Zoccai, Giuseppe, Xu, Bo, Han, Yaling, Genereux, Philippe, Bhatt, Deepak L., Stone, Gregg W, Morice, Marie claude, Hong, Myeong ki, Kim, Byeong keuk, Kim, Hyo soo, Ahn, Jung min, Park, Seung jung, Schã¼pke, Stefanie, Biondi zoccai, Giuseppe, Stone, Gregg W., University of Bologna/Università di Bologna, Instituto de Cardiologia Dante Pazzanese (IDPC), Université de Brest (UBO), Institut Cardiovasculaire Paris Sud [Massy] (ICPS), Inselspital Bern, Yonsei University, Seoul National University [Seoul] (SNU), IRCCS San Raffaele Scientific Institute [Milan, Italie], University of Ulsan, Deutsches Zentrum für Herz-Kreislauf-Forschung partner site, Munich Heart Alliance, German Heart Center = Deutsches Herzzentrum München [Munich, Germany] (GHC), Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, Unité de Recherche Clinique (Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [APHP]), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), Fuwai Hospital of Chinese Academy of Medical Sciences [Beijing, China] (FH-CAMS), General Hospital of Shenyang Military Region [Shenyang, China] (GH-SMR), New York Presbyterian Hospital, Columbia University Medical Center (CUMC), Columbia University [New York], Brigham and Women’s Hospital [Boston, MA], Harvard Medical School [Boston] (HMS), and Lesnik, Philippe

Subjects
medicine.medical_specialty, Multivariate analysis, animal structures, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, MEDLINE, Hemorrhage, 030204 cardiovascular system & hematology, Lower risk, law.invention, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, law, Internal medicine, medicine, Drug-Eluting Stent, drug-eluting stent, dual antiplatelet therapy, 030212 general & internal medicine, dual antiplatelet therapy, mortality, drug-eluting stents, hemorrhage, humans, percutaneous coronary intervention, platelet aggregation inhibitors, postoperative complications, randomized controlled trials as topic, cardiology and cardiovascular medicine, education, Randomized Controlled Trials as Topic, education.field_of_study, business.industry, Platelet Aggregation Inhibitor, Hazard ratio, Confidence interval, Surgery, [SDV] Life Sciences [q-bio], Drug-eluting stent, Postoperative Complication, business, Cardiology and Cardiovascular Medicine, Human
Abstract

Background Although some randomized controlled trials (RCTs) and meta-analyses have suggested that prolonged dual-antiplatelet therapy (DAPT) may be associated with increased mortality, the mechanistic underpinnings of this association remain unclear. Objectives The aim of this study was to analyze the associations among bleeding, mortality, and DAPT duration after drug-eluting stent implantation in a meta-analysis of RCTs. Methods RCTs comparing different DAPT durations after drug-eluting stent placement were sought through the MEDLINE, Embase, and Cochrane databases and the proceedings of international meetings. Deaths were considered possibly bleeding related if occurring within 1 year of the episodes of bleeding. Primary analysis was by intention-to-treat. Secondary analysis was performed in a modified intention-to-treat population in which events occurring when all patients were on DAPT were excluded. Results Individual patient data were obtained for 6 RCTs, and aggregate data were available for 12 RCTs. Patients with bleeding had significantly higher rates of mortality compared with those without, and in a time-adjusted multivariate analysis, bleeding was an independent predictor of mortality occurring within 1 year of the bleeding episode (hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p< 0.0001). Shorter DAPT was associated with lower rates of all-cause death compared with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to 1.00; p= 0.05), which was driven by lower rates of bleeding-related deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65; 95% confidence interval: 0.43 to 0.99; p= 0.04). Mortality unrelated to bleeding was comparable between the 2groups. Similar results were apparent in the modified intention-to-treat population. Conclusions Bleeding was strongly associated with the occurrence of mortality within 1 year after the bleeding event. Shorter compared with longer DAPT was associated with lower risk for bleeding-related death, a finding that mayunderlie the lower all-cause mortality with shorter DAPT in the RCTs of different DAPT durations after DES.

Published
2017

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