647 COMPLEX PERCUTANEOUS CORONARY INTERVENTION IN HIGHT BLEEDING AND THROMBOTIC RISK PATIENT: WHICH ANTITHROMBOTIC THERAPY?

Abstract Background Antiplatelet therapy is required in patients with atherosclerotic coronary artery disease (CAD) undergoing percutaneous intervention (PCI) drug-eluting stents (DES). Current European and American guidelines recommend 6 months of DAPT CCS 12 after ACS. However, a shorter duration may be considered high bleeding risk (HBR) patients, longer those at higher thrombotic (HTR). To minimize the events an individual patient therefore improve overall outcomes PCI, stratification essential. In particular, characteristics must weighed on case-by-case basis to tailor antiplatelet strategies decisions over patient's profile. We describe illustrative case complex PCI ACS which defining appropriate clinical challenge. Clinical A 68-year-old man ACS-NSTEMI anemia was hospitalized intensive care unit. His medical history notable for hypertension, dyslipidemia, diabetes mellitus, diabetic retinopathy, chronic kidney (CKD) paroxysmal atrial fibrillation. transthoracic echocardiogram showed left ventricular ejection fraction 30% diffuse hypokinesia, without relevant valvular disease. He conducted cath-lab diagnostic angiogram three-vessel critical CAD. After Heart Team evaluation bypass surgery (CABG) indicated. during hospitalization unit there worsening conditions cognitive impairment due mesencephalic stroke leading new assessment that indicated stabilization scenario. two weeks IVUS guided PCI. right performed implantation 1 DES (3.0/30 mm) middle segment (4.0/15 ostial segment. main bifurcation 2 (4.0/28 culotte technique. Patients have both HBR HTR, therefore, procedure, trade off model score introduced by Academic Research Consoritum (ARC) applied. Based his factor, predicted 1-y BARC type 3 5 (51.41%) greater than myocardial infarction or (25.00%). this result we decided prescribe Triple antithrombotic week, dual only oral anticoagulation. Conclusion context several factor mandatory define DAPT. The trade-off important useful tool identify who might benefit from individualized durations depending balance between HTR characteristics.