PCI Patients: Better Off with DES and Standard DAPT

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fairly difficult
Nanocoated stent and very short DAPT don't mitigate high bleeding risk in COBRA-REDUCE
People on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) did not fare well with a treatment tailored to their high bleeding risk -- Cobra PzF stent implantation and a short duration of dual antiplatelet therapy (DAPT) -- the COBRA-REDUCE trial showed.

At 6 months, the rate of actionable bleeds was similar between those randomized to Cobra PzF stenting with 14 days of DAPT and peers who had second-generation drug-eluting stent (DES) placement followed by the standard 3-6 months of DAPT (BARC 2-5 bleeding 7.5% vs 8.9%, P=0.477).

The lack of a significant reduction in bleeding was "somewhat surprising," as the hypothesis of the study had been that the Cobra PzF group would have a superior outcome, according to Robert Byrne, MB BCh, PhD, of Mater Private Hospital, RCSI University in Dublin, in a presentation at the virtual TCT Connect conference.

The Cobra PzF and short DAPT strategy also failed to meet non-inferiority in terms of thrombotic events (combined incidence of death, myocardial infarction (MI), stent thrombosis, and ischemic stroke) at 7.7% versus 5.2% of controls (P=0.061 for non-inferiority).

No between-group differences were found in the individual endpoints of all cause death, cardiac death, MI, stent thrombosis, or ischemic stroke. Only excess ischemia-driven target lesion revascularization (TLR) was suggested for the Cobra PzF strategy (3.7% vs 0.9%, P=0.004).

Byrne highlighted the low event rates in both groups -- especially the 0.6% incidence of stent thrombosis in both study arms -- and the "very good…
Nicole Lou
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