P3180The effect of PCI complexity on the efficacy and safety of dabigatran dual therapy vs warfarin triple therapy in atrial fibrillation: a subgroup analysis from the RE-DUAL PCI trial

Background: Dual antiplatelet therapy (DAPT) prevents ischemic events after coronary stenting, but increases bleeding. Complex percutaneous coronary intervention (PCI) carries an intrinsic higher risk for ischemic recurrences, and while guidelines support the use of dedicated clinical risk scores prior to the selection of DAPT duration, validation of these tools in the setting of complex coronary intervention has not been yet provided. Purpose: We aimed to test the value of the PRECISE-DAPT score, a standardized tool for DAPT duration decision-making, among patients undergoing complex PCI. Methods: Complex PCI was defined as 3 stents implanted and/or 3 lesions treated and/or bifurcation with 2 stents implanted and/or total stent length >60 mm and/or chronic total occlusion as target lesion. Ischemic and bleeding outcomes for patients with high (25) or non-high (<25) PRECISE-DAPT score were evaluated according to the presence or the absence of complex PCI. Results: Among 14,963 patients from the PRECISE-DAPT study population, a total of 3,118 patients underwent complex PCI. Consistent to the PRECISE-DAPT decision-making algorhythm, TIMI Bleeding were significantly increased by a longer DAPT treatment only in patients with a high PRECISE-DAPT score, with no heterogeneity among the group with or without complex PCI (Pint 0.89). Irrespective of PCI complexity, the composite ischemic endpoint was reduced with a longer DAPT treatment exclusively among patients with non-high score (noncomplex PCI: ARD -1.14%, 95% CI -2.26% to -0.02; complex PCI: ARD -3.86%, 95% CI -7.71% to +0.06) (Pint 0.19), whereas no advantage was observed in patients with high score (Pint 0.97). Net adverse clinical events (composite of ischemia and bleeding) in patients with complex PCI were significantly reduced by a longer DAPT treatment only in case of non-high score (ARD -4.05%, 95% CI -7.96% to -0.07), whereas no benefit was observed among patients at high score irrespective of PCI complexity (Pint 0.83).