3-month DAPT noninferior to 12-month after PCI using third-generation stents
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Key takeaways:
- Three-month DAPT was noninferior to 12-month DAPT after PCI with third-generation stents.
- The HOST-IDEA trial excluded patients with STEMI.
- Target lesion failure and major bleeding risk were similar.
NEW ORLEANS — An all-comers trial excluding patients with STEMI showed that after PCI, 3-month dual antiplatelet therapy was noninferior to 12-month DAPT for the composite outcome of net adverse clinical events, a speaker reported.
The results of the HOST-IDEA trial were presented at the American College of Cardiology Scientific Session and simultaneously published in Circulation.
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“Current guidelines recommend DAPT from 6 months in stable cases and 12 months in unstable cases,” Hyo-Soo Kim, MD, PhD, of the Cardiovascular Center at Seoul National University Hospital, South Korea, said during a presentation. “Third-generation [drug-eluting stents] with ultrathin struts and advanced polymer technology have theoretical benefits that minimize the risk of stent-related complications. Third-generation DES may allow shortened default duration of DAPT, but data are limited regarding short-term DAPT after PCI using third-generation DES with ultrathin struts.”
HOST-IDEA was a randomized, open-label, multicenter trial comparing antiplatelet monotherapy after 3-month DAPT with 12-month DAPT in an all-comers cohort of 2,013 patients with de novo stenotic lesions (mean age, 66 years; 74% men) who did not have STEMI and underwent PCI with third-generation DES with the thinnest struts (Orsiro, Biotronik; Coroflex ISAR, B. Braun).
The primary endpoint was a composite of cardiac death, target vessel MI, clinically driven target lesion revascularization, stent thrombosis and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 12 months.
Approximately 45% of the cohort had a clinical diagnosis of stable ischemic heart disease at index PCI, and the rest had ACS (non-STEMI or unstable angina).
Nearly all participants were prescribed DAPT with aspirin and clopidogrel after PCI.
Kim and colleagues observed that the risk for the primary endpoint at 1 year was not significantly different between patients assigned to antiplatelet monotherapy after 3-month DAPT compared with 12-month DAPT (absolute risk difference, 0.4%; P for noninferiority < .001; HR = 0.93; 95% CI, 0.6-1.45; P for superiority = .75).
The 1-year risk for target lesion failure (HR = 0.98; 95% CI, 0.56-1.71; P = .94) and BARC type 3 or 5 major bleeding (HR = 0.82; 95% CI, 0.41-1.61; P = .56) was not significantly different between the groups.
Risk for the primary endpoint, TLF and BARC type 3 or 5 bleeding was comparably elevated in the first 90 days after PCI in both study arms and incidence was similar between the two groups.
These findings were consistent across all prespecified subgroups, including patients who presented with nonfatal MI (HR = 0.83; 95% CI, 0.3-2.3; P = .72), according to the presentation.
“One thing that we observed in this study is good performance of clopidogrel, at least [in this Asian cohort],” Kim said. “Although more than half of the patients in our study presented with ACS — of course, we excluded STEMI — a majority used clopidogrel showing excellent results. Among the general population, excluded patients with STEMI, 3-month DAPT was noninferior to 12-month DAPT for [net adverse clinical events] at 1 year after PCI using third-generation DES with ultrathin struts.”
Reference:
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Kim HS, et al. Featured Clinical Research II. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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