The Twilight Trial

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 3 The Twilight Trial: Ticagrelor with or without aspirin in high-risk patients after PCI Author: Vladimir Dzavik, MD, PhD, Toronto General Hospital, Canada TRIAL HYPOTHESIS In patients undergoing PCI who are at high risk for ischemic or hemorrhagic complications and who have completed a 3-month course of dual antiplatelet therapy with ticagrelor plus aspirin, continued treatment with ticagrelor monotherapy would be superior to ticagrelor plus aspirin with respect to clinically relevant bleeding and would not lead to ischemic harm. TRIAL OBJECTIVES Primary Objective: To determine the impact of SAPT (ticagrelor monotherapy) versus DAPT (ticagrelor plus aspirin) for 12 months in reducing clinically relevant bleeding (BARC 2, 3 or 5) among high-risk patients who have undergone successful PCI. Secondary Objective: To determine the impact of SAPT (ticagrelor monotherapy) versus DAPT (ticagrelor plus aspirin) for 12 months on major ischemic adverse events (all-cause death, non-fatal MI or stroke) among high-risk patients who have undergone successful PCI. CONCLUSION In high-risk patients who underwent PCI and were treated with ticagrelor and aspirin for 3 months without any major adverse (bleeding or ischemic) events, an antiplatelet strategy of continuing ticagrelor monotherapy resulted in: substantially less bleeding than ticagrelor plus aspirin without increasing ischemic events over a period of 1 year

Stop DAPT2 High Bleeding Risk sub analysis

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 STOPDAPT2 HBR Bifurcation. 1 Year outcomes from a Randomized Trial of Clopidogrel Monotherapy VS DAPT Beginning 1 Month After PCI in Patients at High Bleeding Risk Author: Hirotoshi Watanabe, MD, Kyoto University Hospital, Japan LIMITATIONS Post-hoc, and underpowered analysis. Precise ARC-HBR could not be applied.  Very few patients participated in this study with 2-stents for bifurcation. Japanese patients are known to have lower ischemic risk and higher bleeding risk compared with US/European population CONCLUSION The effects of 1-month DAPT versus 12-month DAPT on the primary and major secondary endpoints were consistent in HBR patients and any bifurcation strategy without any significant interactions. One-month DAPT was associated with significant reduction of major bleeding without any increase of cardiovascular events in HBR patients, and the absolute magnitude of bleeding events with 1-month DAPT was numerically greater in HBR patients than in non-HBR patients, although the analysis was underpowered and needed confirmation in future studies. In this study very few patients with complex PCI for bifurcation participated, but there was no sign 1-month DAPT significantly increased the coronary-related events

Double Debulking for LM True Bifurcation Lesion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Double Debulking for LM True Bifurcation Lesion Author: Yoshihisa Kinoshita, MD, Toyohashi Heart Center, Japan CONCLUSION Although short DAPT theory becomes widespread recently, we have to keep DAPT after stenting at least 3 to 6 months at least. Especially, it is difficult to stop DAPT within 1 month for the patient who have stent in LM bifurcation lesion. However, there are some patients who cannot continue enough DAPT because of their underlying condition. Aggressive debulking without stenting occasionally brings a favorable result for such patients.

Debiut

European Bifurcation Club 2010, EBC 2010 - Budapest, Hungary Hot topics Drug Eluting Balloon in Bifurcations Trial : DEBIUT Author: Pierfrancesco Agostoni MD, PhD, University Medical Centre Utrecht, The Netherlands

DAPT duration After Bifurcation stenting

European Bifurcation Club 2018 - EBC 2018 - Brussels, Belgium CONSENSUS SESSION Consensus Session DAPT duration After Bifurcation stenting Author: Hyeon Cheol Gwon, Bernard Chevalier