P4569Duration of dual anti platelet therapy in elective drug coated balloon angioplasty

Abstract

Aims: The duration of dual antiplatelet therapy (DAPT) for drug coated balloon (DCB) angioplasty in elective percutaneous coronary angioplasty (PCI) guidelines have been reviewed in 2017. Previous German Consensus Group guidelines (2011) advised 1 month only of DAPT for patients with stable coronary artery disease after DCB PCI. This was based on small-moderate randomized controlled studies and large prospective worldwide registries. [1] This shorter duration of DAPT is attractive in bleeding risk reduction. The European Society of Cardiology Focused Update on DAPT 2017 advises 6 months of DAPT. [2] This is not in keeping with practice of centres doing large volume DCB angioplasty. We report outcomes of elective DCB angioplasty with DAPT for 1 month only. Methods and results: We identified 361 lesions from our database undergoing elective DCB angioplasty between 01/04/2012- 31/03/2017 with a 1-month duration of DAPT. This includes both de novo lesions and in-stent restenosis (ISR) lesions. Clinical outcomes were obtained through clinical records and up-to-date mortality data was obtained from the Demographic Batch Service Bureau of the Health and Social Care Information Centre. Primary outcomes were 6-month lesion thrombosis, 6-month treated-lesion myocardial infarction and 6-month cardiac death. Secondary outcomes were 6-month target lesion revascularization (TLR), 6-month all-cause mortality and 6-month non-treated lesion myocardial infarction. Mean age of the cohort was 67 with 284 (78.7%) male. 315 (87.3%) were de novo lesions with 46 (12.7%) for TLR. 92% of patients had clinical follow-up at 6 months. Primary outcomes: No reported occurrences of lesion thrombosis, target lesion MI or cardiac death at 6 months. Secondary outcomes: no TLRs at 6-months; 1 (0.28%) all-cause mortality at 50 days was due to end stage renal failure; and 2 (0.55%) non-target vessel MIs (49 and 156 days). On both follow-up angiograms, the treated lesion result remained acceptable. Discussion: 1 month only of dual antiplatelet therapy appears safe in prevention of lesion thrombosis, acute myocardial infarction and cardiac death in DCB-PCI. This correlates with previous outcomes from prospective registries and RCTs and brings into question the recently changed guidelines.