Intracoronary Imaging-Guided Discontinuation of Dual Antiplatelet Therapy in Stented Patients Requiring Expedited Cancer Treatment

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JACC (Journal of the American College of Cardiology)


Background: Cancer care could be expedited by identifying patients at low thrombotic risk who can safely discontinue dual antiplatelet therapy (DAPT) early after percutaneous coronary intervention (PCI) with drug eluting stents (DES). We aimed to assess the safety of DAPT discontinuation based on intracoronary imaging either immediately after PCI, or in a remote procedure before planned DAPT discontinuation. Methods: We performed a retrospective study of consecutive cancer patients who underwent PCI with DES from 2/2011 to 8/2017. We divided patients in 2 groups: those with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) immediately after PCI, and those with OCT in a second procedure, before planned DAPT discontinuation. Patients were considered low thrombotic risk if adequate stent expansion and apposition were found on the initial procedure, or adequate stent expansion, coverage, apposition, without significant in-stent restenosis were found on a consecutive procedure. Results: We identified 89 cancer patients with DES. 49 had IVUS/OCT immediately after PCI, while 40 had OCT before proposed DAPT discontinuation. MACE (p = 0.37) and survival (p = 0.74) were equivalent. Conclusion: Identifying patients at low thrombotic risk with OCT or IVUS yields the same benefit as repeat testing before planned DAPT discontinuation, potentially deferring additional invasive coronary imaging. Stent healing patterns in cancer patients require further study.





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