• Plinio Cirillo, Luigi DI Serafino, Habib Gamra, Marco Zimarino, Emanuele Barbato, Carlo Briguori, Ignatio J Amat-Santos, Alaide Chieffo, Andrejs Erglis, Robert J Gil, Sasko A Kedev, Ivo Petrov, Francesco Radico, Tullio Niglio, Sunao Nakamura, Ricardo A Costa, Vojko Kanic, Matteo Perfetti, Mariano Pellicano, Kristina Maric, Tullio Tesorio, Vladan Vukcevic, Giovanni Esposito, Goran Stankovic, and EuroBifurcation Club.
• Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy - pcirillo@unina.it.
• Panminerva Med. 2023 Mar 1; 65 (1): 1121-12.

BackgroundOptimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) of a bifurcation stenosis is still debated. We evaluated the impact of DAPT duration on clinical outcomes in all-comers patients undergoing bifurcation PCI included in the European Bifurcation Club (EBC) registry.MethodsWe enrolled 2284 consecutive patients who completed at least 18 months follow-up. The cumulative occurrence of major adverse cardiac and cardiovascular events (MACCE), defined as a composite of overall-death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke were evaluated. Bleedings classified as Bleeding Academic Research Consortium (BARC) ≥3 were evaluated too.ResultsPatients were divided into 3 groups: short DAPT (<6-months, N.=375); standard DAPT (≥6-months but ≤12-months, N.=636); prolonged DAPT (>12-months, N.=1273). At 24 months follow-up MACCE-free survival was significantly lower in short DAPT patients (Log-Rank: 45.23, P for trend <0.001). MACCE occurred less frequently in the prolonged DAPT group (148 [11.6%]) as compared with both the short (83 [22.1%] HR: 0.48 [0.37-0.63], P<0.001) and standard DAPT groups (137 [21.5%] HR:0.51 [0.41-0.65], P<0.001). These differences remain after propensity score adjustment (respectively, HR: 0.27 [0.20-0.36] and HR: 0.44 [0.34-0.57]). Such finding was consistent in patients presenting with both acute and chronic coronary syndromes. BARC≥3 bleedings were 0.3% in the standard DAPT, 1.6% in short and 1.9% in prolonged DAPT groups.ConclusionsIn the "real-world" EBC registry of patients undergoing PCI of coronary artery bifurcation stenosis, a prolonged DAPT duration was associated with a significantly lower risk of MACCE and a potential increased risk of major bleedings.

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