Stenting strategy challenged by new data
The European Bifurcation Club Left Main (EBC MAIN) trial has delivered ambivalent results on the question of planned single-stent versus upfront two-stent strategy for true bifurcation distal left main disease.
The primary composite endpoint of one-year death, myocardial infarction and target lesion revascularisation occurred at the rate of 14.7% in the provisional single stent group versus 17.7% in the upfront two-stent group (HR 0.8).
The overall neutral findings are inconsistent with a 2018 European Society of Cardiology (ESC) recommendation to preferably use double-kissing crush (an upfront two-stent technique) over a planned single-stent strategy. The recommendation was largely based on the results of a single randomised study, the DKCRUSH-V trial.
“In this respect, the EBC MAIN trial, presented on May 19 at EuroPCR 2021, adds important new data that deviate from the hitherto available randomised evidence on this topic,” an ESC statement said.
Survival data post-AMI provides clues for improvement
The 7-year survival for patients hospitalised with a first acute myocardial infarction (AMI) under 65 years of age, and for those who have undergone revascularisation, exceeds 80%.
However more effort is required on older patients with NSTEMI.
A study of 239,402 admissions with AMI found the overall survival at 7-years was 62.3%.
“Survival during the first six months was lower among patients with STEMI than those with NSTEMI, but 7-year survival was higher (70.8% v 59.2%).”
Long term survival declined with age at the time of the AMI from 90.5% for patients aged 18‒54 years and 85.5% for those aged 55‒64 years, but 17.4% for patients aged 85 years or more.
“Efforts to improve AMI care should target older patients with NSTEMI, who often have multiple comorbid conditions, and for whom revascularisation rates are low and the prognosis after AMI poor,” the study concluded.
No sex differences in risks of aspirin withdrawal after PCI
In patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), women benefit as much as men from early aspirin withdrawal and continuation of ticagrelor therapy, a new study shows.
A subgroup analysis of the TWILIGHT randomised clinical trial that involved 7119 patients undergoing PCI showed that women had a higher bleeding risk compared with men, though this was mostly attributable to baseline differences.
The study showed that ticagrelor monotherapy was associated with lower risk of major bleeding events compared to DAPT in women (adjusted HR, 0.62;) and men (adjusted HR, 0.57).
Ischaemic end points were similar between treatment groups in both sexes.