Health Condition 1: I259- Chronic ischemic heart disease, unspecified Health Condition 2: null- High Bleeding Risk Patients with myocardial ischemia
Conditions
Interventions
Intervention1: abbreviated dual antiplatelet therapy (DAPT): Patients not on oral anticoagulant (OAC): DAPT is discontinued and a single anti-platelet agent (SAPT) is continued until at least 11 month
Sponsors
European Cardiovascular Research Institute ECRI
Eligibility
Inclusion criteria
Inclusion criteria: Inclusion criteria after index PCI After index PCI, patients aged 18 years or more are eligible for inclusion into the study if the following criteria are met. 1. At least one among the HBR criteria (as defined below) is met. 2. All lesions are successfully treated with Ultimaster stent in the context of 3. routine clinical care, i.e. post-procedural angiographic diameter stenosis 4. Free from any flow-limiting angiographic complications (i.e. significant untreated dissection or major side-branch occlusion), which require prolonged 5. DAPT duration based on operatorâ??s opinion. 6. All stages of PCI are complete (if any) and no further PCI is planned. Inclusion criteria at one-month randomization visit At randomization visit (one month after index PCI), the following criteria must be met: 1. Fulfilment of at least one HBR criterion (as defined below), or on the basis of post-PCI actionable (i.e. requiring medical attention) non-access site related bleeding episode 2. Uneventful 30-day clinical course, i.e. free from spontaneous MI, symptomatic restenosis, stent thrombosis, stroke and any revascularization (coronary and non-coronary) requiring prolonged DAPT 3. If not on OAC, a. Patient is on a DAPT regimen of aspirin and a P2Y12 inhibitor b. Patient with one type of P2Y12 inhibitor for at least 7 days (i.e. no switching between oral P2Y12 inhibitors has occurred in the previous 7 days) 4. If on OAC a. Patient is on the same type of OAC (e.g. Vitamin K antagonist or NOAC) for at least 7 days b. Patient is on clopidogrel for at least 7 days Definition of HBR Post-PCI patients are at HBR if at least one of the following criteria applies: 1. Clinical indication for treatment with oral anticoagulants (OAC) for at least 12 months 2. Recent ( 3. Previous bleeding episode(s) which required hospitalization if the underlying cause has not been definitively treated (i.e. surgical removal of the bleeding source) 4. Age equal or greater than 75 years 5. Systemic conditions associated with an increased bleeding risk (e.g. haematological disorders, including a history of or current thrombocytopaenia defined as a platelet count increased bleeding risk. 6. Documented anaemia defined as repeated haemoglobin levels 7. Need for chronic treatment with steroids or non-steroidal anti-inflammatory drugs 8. Diagnosed malignancy (other than skin) considered at high bleeding risk including gastro-intestinal, genito-urethral/renal and pulmonary. 9. Stroke at any time or TIA in the previous 6 months 10. PRECISE DAPT score of 25 or greater
Exclusion criteria
Exclusion criteria: Patients are not eligible if any of the following applies 1. Treated with stents other than Ultimaster stent within 6 months prior to index procedure 2. Treated for in-stent restenosis or stent thrombosis at index PCI or within 6 months before 3. Treated with a bioresorbable scaffold at any time prior to index procedure 4. Cannot provide written informed consent 5. Under judicial protection, tutorship or curatorship 6. Unable to understand and follow study-related instructions or unable to comply with study protocol 7. Active bleeding requiring medical attention (BARC>=2) on randomization visit 8. Life expectancy less than one year 9. Known hypersensitivity or allergy for aspirin, clopidogrel, ticagrelor, prasugrel, cobalt chromium or sirolimus 10. Any planned and anticipated PCI 11. Participation in another trial 12. Pregnant or breast feeding women
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| This study has 3 primary endpoints: 1) Net adverse clinical endpoints (NACE) defined as a composite of all-cause death,myocardial infarction,stroke,bleeding events (BARC 3 and 5) 2) Major adverse cardiac and cerebral events (MACCE) defined as a composite of all-cause death, myocardial infarction, stroke 3) Major or clinically relevant non-major bleeding (MCB) defined as a composite of bleeding events according to BARC type 2, 3 and 5Timepoint: from randomization up to 11 months after | — |
Secondary
| Measure | Time frame |
|---|---|
| 1) The individual components of each composite primary endpoints 2) The composite of cardiovascular death, MI, and stroke 3) The composite of cardiovascular death, MI, and any revascularization 4) Death from cardiovascular causes 5) The composite of definite or probable stent thrombosis 6) Myocardial infarction Timepoint: from randomization up to 14 months after;7) Any target vessel revascularization 8) Urgent target vessel revascularization 9) Urgent non-target vessel revascularization 10) Clinically indicated non-target vessel revascularization 11) Bleeding events according to the BARC, TIMI and GUSTO classification 12) Transfusion rates both in patients with and/or without clinically detected overt bleedingTimepoint: from randomization up to 14 months after | — |
Countries
Argentina, Australia, Austria, Bahrain, Bangladesh, Belgium, Bulgaria, Colombia, Czech Republic, Denmark, Estonia, France, Germany, Hungary, India, Israel, Italy, Japan, Netherlands, Poland, Portugal, Republic of Korea, Saudi Arabia, Serbia, Singapore, Slovenia, Spain, Sweden, Switzerland, United Kingdom, Viet Nam
Contacts
Public ContactSankardas Mullasari Ajit
Madras Medical Mission
Outcome results
None listed