One month DAPT good enough in complex PCI patients with high bleeding risk

Switzerland: High bleeding risk patients who have undergone percutaneous coronary intervention (PCI), 1 month of dual antiplatelet therapy (DAPT) was associated with a similar rate of major adverse cardiac or cerebral events but a lower bleeding risk than a longer duration of DAPT, even in patients undergoing complex PCI, finds a new analysis of the MASTER DAPT study.

Dual antiplatelet treatment (DAPT) termination at one month was linked with equivalent net adverse clinical events (NACE) and major adverse cardiac or cerebral events (MACCE) and decreased bleeding rates in high bleeding risk (HBR) patients free of recurrent ischemic episodes, regardless of PCI or patient complexity,

The article has been published in European Heart journal.

Patients having percutaneous coronary intervention (PCI) with extensive coronary artery disease (CAD) and problematic lesion subgroups require sophisticated procedures and are at elevated risk of short- and long-term unfavorable ischemic events. As a result, Marco Valgimigli and colleagues conducted this study to evaluate the effects of 1- or 3-month a double antiplatelet therapy in high bleeding risk patients receiving biodegradable-polymer sirolimus-eluting stents for complicated percutaneous coronary intervention and/or acute coronary syndrome (ACS).

The MASTER DAPT experiment included 3383 patients who had noncomplex PCI (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 who had complex PCI (abbreviated DAPT, n = 588; standard DAPT, n = 608). Net adverse clinical events (NACE; a composite of all-cause death, stroke, myocardial infarction, and Bleeding Academic Research Consortium [BARC] 3 or 5 bleeding events); major adverse cardiac or cerebral events (myocardial infarction, all-cause death, and stroke); and type 2, 3, or 5 BARC bleeding were the co-primary outcomes at 335 days.

The key findings of this study were as follows:

1. NACE and MACCE did not vary between patients with difficult and noncomplex PCI who received shortened versus standard DAPT.

2. In patients with and without difficult PCI, BARC 2, 3, or 5 were lowered with shortened DAPT.

3. NACE and MACCE did not differ among the 2,816 patients with complicated PCI and/or ACS, while BARC 2, 3, or 5 was lower with shorter DAPT.

In conclusion, in HBR patients who received complicated or noncomplex PCI with biodegradable-polymer sirolimus-eluting stent implantation and did not experience early recurrent ischemia episodes, discontinuing DAPT a median of 34 days after PCI was consistently associated with similar rates of NACE and MACCE and a decreased risk of major or clinically significant nonmajor bleeding, compared with continuing therapy for a median period of 193 days.

Reference:

Valgimigli, M., Smits, P. C., Frigoli, E., Bongiovanni, D., Tijssen, J., Hovasse, T., Mafragi, Al., Ruifrok, W. T., Karageorgiev, D., Aminian, A., Garducci, S., Merkely, B.,… Belle, L. (2022). Duration of Antiplatelet Therapy After Complex Percutaneous Coronary Intervention In Patients at High Bleeding Risk: a MASTER DAPT trial sub-analysis. In European Heart Journal. Oxford University Press (OUP). https://doi.org/10.1093/eurheartj/ehac284