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Background: Prolonged dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is associated with increased bleeding, despite a reduced incidence of ischemic events. The SYNERGY everolimus-eluting stent is a thin-strut platinum-chromium stent that elutes everolimus from a thin abluminal layer of bioabsorbable polymer. These design elements may facilitate rapid endothelialization and enable shorter-duration DAPT. Methods: EVOLVE Short DAPT prospectively evaluated the safety of 3-month DAPT in high bleeding risk patients treated with the SYNERGY everolimus-eluting stent, enrolling 2009 patients at 110 global sites. Patients with acute myocardial infarction or complex lesions were excluded. After percutaneous coronary intervention, patients were required to take DAPT (aspirin+P2Y 12 inhibitor) for 3 months, except those on chronic anticoagulation in whom aspirin was optional. Patients free of events (stroke, myocardial infarction, revascularization, and stent thrombosis) who discontinued P2Y 12 inhibitor at 3 months, but continued aspirin, and had at least 1 year of follow-up or an end point event were included in the primary analysis. Two powered coprimary end points were (1) death/myocardial infarction compared with a historical control and (2) study stent-related definite/probable stent thrombosis compared to a performance goal. Results: The analysis population consisted of 1487 patients. The adjusted rate of death/myocardial infarction between 3 and 15 months was 5.6% among patients receiving 3-month DAPT versus 5.7% patients in the 12-month DAPT control (propensity adjusted difference=−0.12%; 97.5% upper bound=1.63% which was less than the prespecified margin of 2.52; P non-inferiority =0.0016). The rate of study stent-related stent thrombosis between 3-15 months was 0.2% in the 3-month DAPT group (97.5% upper bound=0.63%; P =0.0005 for comparison to 1% performance goal). Conclusions: Favorable rates of ischemic outcomes were observed among selected high bleeding risk patients undergoing percutaneous coronary intervention with the SYNERGY everolimus-eluting stent who tolerated 3 months of P2Y 12 inhibitor and then discontinued it, supporting the safety of abbreviated DAPT with this stent platform. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02605447.

SYNERGY stent was designed to improve arterial healing and reduce the risk of stent thrombosis (ST) with thin struts and abluminal everolimus-eluting bioabsorbable polymer. Safety and efficacy of SYNERGY has been established in normal bleeding risk patients treated with standard duration DAPT.

The SYNERGY stent (Boston Scientific) is a thin-strut platinum chromium metal alloy platform eluting everolimus from an ultrathin abluminal layer of poly(DL-lactide-co-glycolide) bioabsorbable polymer. Drug release and polymer degradation are complete within 4 months of implantation. These design

Compression of the left main coronary artery (LMCA) has been reported with pulmonary artery enlargement but rarely from aortic pathology. A 75-year-old man with history of mechanical aortic valve replacement (AVR) with aortic conduit for severe aortic insufficiency underwent routine screening

Nuclear stress testing remains the most common non-invasive means to assess for obstructive coronary artery disease (CAD). Despite the prognostic utility of the test, equivocal results are common. The significance of ischemic electrocardiographic changes in the presence of normal myocardial

Biventricular pacing for the treatment of congestive heart failure is now one of the forefront therapies for symptomatic heart failure patients who are receiving maximal medical therapy. Recent advances in lead technology and delivery systems have improved the success rates of left ventricular (LV) lead implantation. A major difficulty in LV lead implantation, however, occurs in patients with coronary vein stenoses, insufficient coronary vein caliber, or significant variations in coronary venous anatomy, in terms of left ventricular lead implantation. We sought to examine whether cardiac vein angioplasty and/or stenting would allow for the proper placement of the LV lead in these patients.