Clinical practice guidelines recommend extending dual antiplatelet therapy (DAPT) beyond 1 year after acute coronary syndrome (ACS) in patients with high ischemic risk and without high bleeding risk. The aim of this study was to identify variables associated with DAPT prolongation in a cohort of 1967 consecutive patients discharged after ACS without thrombotic or hemorrhagic events during the following year. The sample was stratified according to whether DAPT was extended beyond 1 year, and the factors associated with this strategy were analyzed. In 32.2% of the patients, DAPT was extended beyond 1 year. Overall, 770 patients (39.1%) were considered candidates for extended treatment based on PEGASUS criteria and absence of high bleeding risk, and DAPT was extended in 34.4% of them. The presence of a PEGASUS criterion was associated with extended DAPT in the univariate analysis, but not history of bleeding or a high bleeding risk. In the multivariate analysis, a history of percutaneous coronary intervention (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.4–2.4), stent thrombosis (OR = 3.8, 95% CI 1.7–8.9), coronary artery disease complexity (OR = 1.3, 95% CI 1.1–1.5), reinfarction (OR = 4.1, 95% CI 1.6–10.4), and clopidogrel use (OR = 1.3, 95% CI 1.1–1.6) were significantly associated with extended use. DAPT was extended in 32.2% of patients who survived ACS without thrombotic or hemorrhagic events. This percentage was 34.4% when the candidates were analyzed according to clinical guidelines. Neither the PEGASUS criteria nor the bleeding risk was independently associated with this strategy.

Background In the last years a substantial effort has been made to improve the understanding of the sex-differences in cardiovascular disease. However, no studies have examined differences in presentation and outcomes between men and women presenting with syncope and bundle branch block (BBB). Aim To determinate if there are sex-specific differences in the characteristics and outcomes of syncope in patients with BBB Methods Cohort study carried out in a tertiary hospital that is a reference center for syncope from January 2008 to February 2021. Patients (p.) with BBB and syncope of unknown origin after the initial evaluation without direct indication of an ICD were included. They were managed according to the current ESC guidelines. All patients underwent to an EPS and an ILR was implanted if it was not diagnostic. Results 374p. were included (75±1 y. o; 135 (36%) female). Mean follow up was 2.3±1.6 y.o. No differences in baseline characteristics where found comparing both groups, except that LBBB was more prevalent in female and RBBB in male (Figure 1A). EPS and ILR diagnostic yield was 44%/44% respectively in females and 50% /40% in males (p=ns). However, basal HV interval in EPS was significant shorter in females (Figure 2A). In the multivariate analyses female sex was associated with a significant lower risk of AV block (Figure 1B), and with a trend of less need of a pacemaker implantation (PM) (53% in females, 60% in males) (Log-rank 0.1) (Figure 2B). No significant differences in recurrences neither in mortality rate were found. Conclusions Female patients with syncope and BBB have lower risk of AV block compared to males, and only half of them required a pacemaker implantation. A strategy of direct PM implantation should be avoided, specially in woman. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2