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. 2023 Mar 24:10:1106503.
doi: 10.3389/fcvm.2023.1106503. eCollection 2023.

Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014-2019)

A Mezier  1 , P Motreff  1 , J M Clerc  2 , O Bar  3 , R Deballon  4 , T Demicheli  5 , T Dechery  6 , G Souteyrand  1 , A Py  7 , N Lhoest  8 , T Lhermusier  9 , B Honton  10 , A Gommeaux  11 , J Jeanneteau  12 , P Deharo  13 , H Benamer  14 , G Cayla  15 , R Koning  16 , B Pereira  17 , J P Collet  18 , G Rangé  5
Affiliations

Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014-2019)

A Mezier et al. Front Cardiovasc Med. .

Abstract

Background: while the duration of dual antiplatelet therapy (DAPT) following coronary angioplasty for chronic coronary syndrome (CCS) recommended by the European Society of Cardiology has decreased over the last decade, little is known about the adherence to those guidelines in clinical practice in France.

Aim: To analyze the real duration of DAPT post coronary angioplasty in CCS, as well as the factors affecting this duration.

Methods: Between 2014 and 2019, 8.836 percutaneous coronary interventions for CCS from the France-PCI registry were evaluated, with 1 year follow up, after exclusion of patients receiving oral anticoagulants, procedures performed within one year of an acute coronary syndrome, and repeat angioplasty.

Results: Post-percutaneous coronary intervention (PCI) DAPT duration was > 12 months for 53.1% of patients treated for CCS; 30.5% had a DAPT between 7 and 12 months, and 16.4% a DAPT ≤ 6 months. Patients with L-DAPT (>12 months) were at higher ischemic risk [25.0% of DAPT score ≥2 vs. 18.8% DAPT score ≥2 in S&I-DAPT group (≤12 months)]. The most commonly used P2Y12 inhibitor was clopidogrel (82.2%). The prescription of ticagrelor increased over the period.

Conclusions: post-PCI DAPT duration in CCS was higher than international recommendations in the France PCI registry between 2014 and 2019. More than half of the angioplasty performed for CCS are followed by a DAPT > 12 months. Ischemic risk assessment influences the duration of DAPT. This risk is probably overestimated nowadays, leading to a prolongation of DAPT beyond the recommended durations, thus increasing the bleeding risk.

Keywords: bleeding risk; chronic coronary syndrome; coronary angioplasty; dual antiplatelet therapy; ischemic risk.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart. ACS, acute coronary syndrome; CABG, coronary artery bypass graft; CCS, chronic coronary syndrome; MI, myocardial infarction, NSTEMI, non ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TAVI, Transcatheter aortic valve implantation.
Figure 2
Figure 2
DAPT duration after coronary angioplasty for CCS in the France PCI registry (2014–2019) [n = number of procedures (%)]. CCS, chronic coronary syndrome; S-DAPT, short dual antiplatelet therapy; I-DAPT, short & intermediate dual antiplatelet therapy; L-DAPT, long dual antiplatelet therapy.
Figure 3
Figure 3
Distribution of DAPT duration for CCS post angioplasty by year (%) (2014–2019). DAPT, dual antiplatelet therapy.
Figure 4
Figure 4
Distribution of the DAPT score (A). Distribution of dual antiplatelet therapy duration according to DAPT score (B). DAPT, dual antiplatelet therapy; S&I-DAPT, short and intermediate dual antiplatelet therapy (≤12 months); L-DAPT, long dual antiplatelet therapy (>12 months).
See this image and copyright information in PMC

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