At the ACC.25 Scientific Session, Dr. Anna Bortnick presented findings from the HOST-BR trial, which evaluated the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with varying bleeding risks.
At the ACC.25 Scientific Session, Dr. Anna Bortnick presented findings from the HOST-BR trial, which evaluated the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with varying bleeding risks.
Key Findings from the HOST-BR Trial:
1. Study Design:
• A multicenter, randomized, open-label trial conducted in South Korea.
• Included 4,897 patients undergoing PCI with drug-eluting stents.
• Participants were stratified into high bleeding risk (HBR) and low bleeding risk (LBR) groups based on ARC-HBR criteria.
• HBR patients were randomized to receive either 1-month or 3-month DAPT.
• LBR patients were randomized to receive either 3-month or 12-month DAPT.
2. Primary Endpoints:
• Net Adverse Clinical Events (NACE): composite of all-cause mortality, myocardial infarction (MI), stent thrombosis, stroke, or major bleeding.
• Major Adverse Cardiac and Cerebral Events (MACCE): composite of cardiovascular death, MI, stent thrombosis, or ischemic stroke.
• Bleeding events classified as BARC type 2, 3, or 5.
3. Results in High Bleeding Risk (HBR) Patients:
• 3-month DAPT resulted in a lower incidence of NACE (14.0%) compared to 1-month DAPT (18.4%).
• MACCE rates were also lower with 3-month DAPT (5.8%) versus 1-month DAPT (9.8%).
• No significant difference in bleeding events between the two durations.
4. Results in Low Bleeding Risk (LBR) Patients:
• 3-month DAPT was non-inferior to 12-month DAPT concerning NACE (14.0% vs. 18.4%) and MACCE.
• Significantly lower bleeding rates observed with 3-month DAPT (7.4%) compared to 12-month DAPT (11.7%).
Conclusion:
The HOST-BR trial suggests that a 3-month DAPT regimen post-PCI may offer an optimal balance between reducing ischemic events and minimizing bleeding risks in both high and low bleeding risk patients.
Source:
• ACC.org: HOST-BR: Optimal DAPT Duration in Patients With High and Low Bleeding Risk?
