J Soc Cardiovasc Angiogr Interv. 2026 May 12;5(6):105338. doi: 10.1016/j.jscai.2026.105338. eCollection 2026 Jun.
ABSTRACT
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) for high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) can vary based on individual clinical and lesion characteristics. As bifurcation lesions are associated with a greater risk of ischemic events, it is unknown whether HBR patients with bifurcation lesions can be safely treated with abbreviated DAPT.
METHODS: We examined ischemic and bleeding outcomes in patients with and without bifurcation lesions who underwent PCI with the Resolute Onyx zotarolimus-eluting stent (Medtronic) from the Onyx ONE Clear study. HBR patients free of events through 1 month were prescribed 1 month of DAPT. Outcomes from 1 month to 2 years were analyzed among patients with HBR who underwent successful PCI for at least 1 bifurcation lesion followed by 1-month DAPT.
RESULTS: Of 1507 total HBR patients, 215 (14.3%) underwent PCI of a bifurcation lesion, with 86.6% treated with a provisional approach. Included patients had an average of 1.6 HBR criteria. Patients with bifurcation lesions treated had more stents implanted and longer total length of stents implanted. The composite of cardiac death or myocardial infarction was similar for patients with vs without bifurcation lesions (12.2% vs 11.6%, P = .92). There were no differences in any clinical or angiographic outcomes between groups, including BARC 3 to 5 bleeding events.
CONCLUSIONS: In the Onyx ONE Clear study, HBR patients with bifurcation lesions treated with the Resolute Onyx zotarolimus-eluting stent and 1-month DAPT had comparable ischemic event rates at 2 years compared with patients without bifurcation lesions, despite greater lesion and procedural complexity.
PMID:42516863 | PMC:PMC13404035 | DOI:10.1016/j.jscai.2026.105338