Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial

Koltowski, Lukasz; Tomaniak, Mariusz; Gross, Lisa; Rymuza, Bartosz; Kowara, Michal; Parma, Radoslaw; Komosa, Anna; Klopotowski, Mariusz; Jacobshagen, Claudius; Gori, Tommaso; Aradi, Daniel; Huber, Kurt; Hadamitzky, Martin; Massberg, Steffen; Lesiak, Maciej; Filipiak, Krzysztof J.; Witkowski, Adam; Opolski, Grzegorz; Huczek, Zenon und Sibbing, Dirk (2019): Guided de-escalation of DAPT in acute coronary syndrome patients undergoing percutaneous coronary intervention with BVS implantation: a post-hoc analysis from the randomized TROPICAL-ACS trial. In: Journal of Thrombosis and Thrombolysis, Bd. 47, Nr. 3: S. 427-435

Abstract

To investigate the safety and efficacy of an early platelet function testing (PFT)-guided de-escalation of dual antiplatelet treatment (DAPT) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVS). Early DAPT de-escalation is a new non-inferior alternative to 12-months DAPT in patients with biomarker positive ACS treated with stent implantation. In this post-hoc analysis of the TROPICAL-ACS trial, which randomized 2610 ACS patients to a PFT-guided DAPT de-escalation (switch from prasugrel to clopidogrel) or to control group (uniform prasugrel), we compared clinical outcomes of patients (n=151) who received a BVS during the index PCI. The frequency of the primary endpoint (cardiovascular death, myocardial infarction, stroke or BARC2 bleeding) was 8.8% (n=6) in the de-escalation group vs. 12.0% (n=10) in the control group (HR 0.72, 95% CI 0.26-1.98, p=0.52) at 12 months. One early definite stent thrombosis (ST) occurred in the control group (day 19) and 1 possible ST (sudden cardiovascular death) in the de-escalation group (day 86), both despite prasugrel treatment and in a background of high on-treatment platelet reactivity assessed at day 14 after randomization (ADP-induced platelet aggregation values of 108 U and 59 U, respectively). A PFT-guided DAPT de-escalation strategy could potentially be a safe and effective strategy in ACS patients with BVS implantation but the level of platelet inhibition may be of particular importance. This hypothesis-generating post-hoc analysis requires verification in larger studies with upcoming BVS platforms.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0929-5305
• Sprache: Englisch