Early Aspirin Discontinuation After Coronary Stenting: A Systematic Review and Meta-Analysis.

Background The clinical impact of early aspirin discontinuation compared with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention with stenting remains poorly studied. We investigated the clinical outcomes of patients assigned to either early aspirin discontinuation or DAPT after percutaneous coronary intervention with stenting. Methods and Results We performed a meta-analysis of aggregate data from randomized clinical trials enrolling participants receiving a percutaneous coronary intervention with stenting and assigned to either early aspirin discontinuation or DAPT. Scientific databases were searched from inception through March 30, 2020. Trial-level hazard ratios (HRs) and 95% CIs were pooled using a random effects model with inverse variance weighting. The primary outcome was all-cause death. Secondary outcomes were myocardial infarction, stent thrombosis, stroke, and major bleeding. Overall, 36 206 participants were allocated to either early aspirin discontinuation (experimental therapy, n=18 088) or DAPT (control therapy, n=18 118) in 7 trials. Median follow-up was 12 months. All-cause death occurred in 2.5% of patients assigned to experimental and 2.9% of patients assigned control therapy (hazard ratio [HR], 0.91, 95% CI, 0.75-1.11; P=0.37). Overall, patients treated with experimental versus control therapy showed no significant difference in terms of myocardial infarction (HR, 1.02 [0.85-1.22], P=0.81), stent thrombosis (HR, 1.02 [0.87-1.20], P=0.83), or stroke (HR, 1.01 [0.68-1.49], P=0.96). However, the risk for major bleeding (HR, 0.58 [0.43-0.77], P<0.01) was significantly reduced by experimental as compared with control therapy. Conclusions In patients treated with percutaneous coronary intervention and stenting, assigned to a strategy of early aspirin discontinuation versus DAPT, the risk of death and ischemic events is not significantly different but the risk of bleeding is lower.

Valor pronóstico de la troponina T de alta sensibilidad tras intervención coronaria percutánea en pacientes con enfermedad coronaria estable / Prognostic value of high-sensitivity troponin T after percutaneous coronary intervention in patients with stable coronary artery disease

Introducción y objetivos: Está por clarificar el valor pronóstico de la troponina T de alta sensibilidad tras una intervención coronaria percutánea en pacientes con enfermedad coronaria estable. Esta cuestión clínicamente relevante se ha investigado en 3.463 pacientes consecutivos a los que se practicó una intervención coronaria percutánea. Métodos: En este estudio se incluyó a pacientes con enfermedad coronaria estable y un valor basal de troponina T de alta sensibilidad menor que el límite superior de referencia del percentil 99 (0,014 μg/l). Se determinó la troponina T de alta sensibilidad antes de la intervención y luego al cabo de 6, 12 y 24 h. El objetivo principal fue la mortalidad por cualquier causa. Resultados: Se clasificó a los pacientes en un grupo con un valor máximo de troponina T tras la intervención ≤ percentil 99 (n = 742), un grupo con un valor máximo de troponina T tras la intervención entre > percentil 99 y 5 veces el percentil 99 (n = 1.928) y un grupo con un valor máximo de troponina T tras la intervención > 5 veces el percentil 99 (n = 793). La edad avanzada, el índice de masa corporal más bajo, el valor de troponina basal, las lesiones complejas, las lesiones en bifurcación y la longitud del stent se asociaron de manera independiente a concentraciones de troponina T aumentadas después de la intervención. La mediana de seguimiento fue de 15,5 meses. Hubo 56 muertes: 5 pacientes (1,7%) con valor máximo de troponina T tras la intervención ≤ percentil 99, 35 (4,5%) con valor máximo de troponina T tras la intervención entre > percentil 99 y 5 veces el percentil 99, y 16 (4,3%) del grupo con valor máximo de troponina T tras la intervención > 5 veces el percentil 99 (hazard ratio = 1,50; intervalo de confianza del 95%, 1,01-2,25; p = 0,047). Tras el ajuste, el valor máximo de troponina T tras el procedimiento no mostró asociación independiente con la mortalidad tras la intervención coronaria percutánea (p = 0,094). Conclusiones: En los pacientes con enfermedad coronaria estable y sin elevación basal de la troponina T de alta sensibilidad, la elevación de esta después de una intervención coronaria percutánea no se asoció a mayor mortalidad tras el procedimiento (AU)

Introduction and objectives: The prognostic value of high-sensitivity troponin T after percutaneous coronary intervention in patients with stable coronary artery disease is unclear. We investigated this clinically relevant question in 3463 consecutive patients undergoing percutaneous coronary intervention. Methods: This study included patients with stable coronary artery disease and baseline high-sensitivity troponin T below the 99th percentile upper reference limit (0.014 μg/L). High-sensitivity troponin T was measured before and at 6, 12 and 24 hours after the procedure. The primary outcome was all-cause mortality. Results: Patients were divided into a group with peak postprocedural troponin T ≤ 99th percentile (n = 742), a group with peak postprocedural troponin T > 99th to 5 × 99th percentile (n = 1928), and a group with peak postprocedural troponin T > 5 × 99th percentile upper reference limit (n = 793). Advanced age, smaller body mass index, baseline troponin level, complex lesions, bifurcation lesions and stented length were independently associated with elevated troponin T levels after the procedure. The median follow-up was 15.5 months. There were 56 deaths: 5 deaths (1.7%) among patients with peak postprocedural troponin T ≤ 99th percentile, 35 deaths (4.5%) among patients with peak postprocedural troponin T > 99th to 5 × 99th percentile and 16 deaths (4.3%) among patients with peak postprocedural troponin T > 5 × 99th percentile upper reference limit (hazard ratio = 1.50; 95% confidence interval, 1.01-2.25; P = .047). After adjustment, peak postprocedural troponin T level was not independently associated with mortality after percutaneous coronary intervention (P = .094). Conclusions: In patients with stable coronary artery disease and without elevated baseline high-sensitivity troponin T, elevated high-sensitivity troponin T level after percutaneous coronary intervention was not associated with postprocedural mortality (AU)

Prognostic Value of High-sensitivity Troponin T After Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease.

INTRODUCTION AND OBJECTIVES: The prognostic value of high-sensitivity troponin T after percutaneous coronary intervention in patients with stable coronary artery disease is unclear. We investigated this clinically relevant question in 3463 consecutive patients undergoing percutaneous coronary intervention. METHODS: This study included patients with stable coronary artery disease and baseline high-sensitivity troponin T below the 99th percentile upper reference limit (0.014µg/L). High-sensitivity troponin T was measured before and at 6, 12 and 24hours after the procedure. The primary outcome was all-cause mortality. RESULTS: Patients were divided into a group with peak postprocedural troponin T≤99th percentile (n=742), a group with peak postprocedural troponin T>99th to 5×99th percentile (n=1928), and a group with peak postprocedural troponin T>5×99th percentile upper reference limit (n=793). Advanced age, smaller body mass index, baseline troponin level, complex lesions, bifurcation lesions and stented length were independently associated with elevated troponin T levels after the procedure. The median follow-up was 15.5 months. There were 56 deaths: 5 deaths (1.7%) among patients with peak postprocedural troponin T≤99th percentile, 35 deaths (4.5%) among patients with peak postprocedural troponin T>99th to 5×99th percentile and 16 deaths (4.3%) among patients with peak postprocedural troponin T>5×99th percentile upper reference limit (hazard ratio=1.50; 95% confidence interval, 1.01-2.25; P=.047). After adjustment, peak postprocedural troponin T level was not independently associated with mortality after percutaneous coronary intervention (P=.094). CONCLUSIONS: In patients with stable coronary artery disease and without elevated baseline high-sensitivity troponin T, elevated high-sensitivity troponin T level after percutaneous coronary intervention was not associated with postprocedural mortality.

Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

OBJECTIVES: We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. METHODS: This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. RESULTS: Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P < 0.001). Access-site bleeding occurred in 730 patients with arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P < 0.001), access-site bleeding (adjusted OR = 1.36 [1.10-1.68], P = 0.005) and non-access-site bleeding (adjusted OR = 1.42 [1.09-1.83], P = 0.008). A history of arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). CONCLUSIONS: Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc.