Kedhi, Elvin and Verdoia, Monica and Suryapranata, Harry and Damen, Sander and Camaro, Cyril and Benit, Edouard and Barbieri, Lucia and Rasoul, Saman and Liew, Houng B. and Polad, Jawed and Ahmad, Wan Azman Wan and Zambahari, Robaayah and Lalmand, Jacques and van der Schaaf, Rene J. and Koh, Tian H. and Timmermans, Philippe and Dilling-Boer, Dagmara and Veenstra, Leo F. and van' t Hof, Arnoud W. J. and Lee, Stephen W. L. and Roolvink, Vincent and Ligtenberg, Erik and Postma, Sonja and Kolkman, Evelien J. J. and Brouwer, Marc A. and Dudek, Dariusz and De Luca, Giuseppe (2021) Impact of age on the comparison between short-term vs 12-month dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-Year follow-up results of the REDUCE trial. Atherosclerosis, 321. pp. 39-44. ISSN 0021-9150, DOI https://doi.org/10.1016/j.atherosclerosis.2021.02.006.
Full text not available from this repository.Abstract
Background and aims: The impact of advanced age on the optimal duration of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary revascularization (PCI) is still greatly debated. Therefore, the aim of the present sub-analysis of the REDUCE trial was to assess the impact of age on the comparison between a short 3 months vs standard 12 months DAPT in ACS patients treated with the COMBO Dual Stent Therapy. Methods: The REDUCE trial is a prospective, multicenter, investigator-initiated study that randomized ACS patients undergoing PCI with the COMBO drug eluting stent to either 3 or 12 months of DAPT. The study population was divided according to age (< or >= 75 years). Primary study endpoint was a composite of all-cause mortality, myocardial infarction, definite/probable stent thrombosis (ST), stroke, target-vessel revascularization (TVR) and bleeding (BARC II, III, V) at 12 months. Secondary endpoints were cardiovascular mortality and the individual components of the primary endpoint within 24 months. Results: From June 2014 to May 2016, 1496 patients were included in the study, of whom 205 (13.7%) >= 75 years of age. Among them, 50.7% of the elderly and 50.2% of younger patients were assigned to the 3-month DAPT treatment. Baseline characteristics were well matched between the two arms, except for a higher rate of males (p=0.02) and a reduced number of lesions on the right coronary artery (p=0.02) in elderly patients treated for the short DAPT duration. Median follow-up was 682.5 days IQR:667-731]. At 12 months, no difference in the primary endpoint was observed according to DAPT duration in both patients aged > 75 years (22.1% vs 18.8%, HR 95%CI] = 1.6 0.73-3.5], p=0.24) and younger ones (9.7% vs 10.9%, HR 95%CI] = 0.85 0.59-1.27], p=0.44; p INT = 0.15). Results were confirmed after correction for baseline differences among the elderly (adjusted HR 95%CI] = 1.7 0.75-3.9], p=0.21). Comparable rates of survival, thrombotic (MI, stent throm-bosis, TVR, stroke) and bleeding events were observed with the two DAPT strategies, with no impact of age. Conclusions: The present study shows that among ACS patients randomized in the REDUCE trial, a 3-month DAPT strategy was comparable to a standard 12-month DAPT at a 2-year follow-up for both ischemic and bleeding endpoints, in elderly and younger patients. Thus, despite presenting the limitations of a subgroup analysis, our study strengthens the feasibility of a shorter DAPT duration even among high-risk subsets of ACS patients.
| Item Type: | Article |
|---|---|
| Funders: | OrbusNeich Medical Inc., Fort Lauderdale, United States of America |
| Uncontrolled Keywords: | Elderly;DAPT duration;ACS;PCI;Mortality;Bleeding;Thrombosis |
| Subjects: | R Medicine R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms Zaharah Ramly |
| Date Deposited: | 30 May 2022 08:04 |
| Last Modified: | 30 May 2022 08:04 |
| URI: | http://eprints.um.edu.my/id/eprint/34619 |
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