Duration of dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI) for bifurcation lesions: insights from the ULTRA-BIFURCAT registry

Background The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains debated, particularly for bifurcation lesions, which are associated with increased thrombotic risk. Purpose To evaluate the impact of different DAPT duration regimens on clinical outcomes in a large cohort of patients treated with PCI on bifurcation lesions. Methods This study analyzed data from the BIFURCAT-ULTRA registry, including patients treated with PCI for bifurcation lesions. DAPT duration was categorized as <6, 6–11, 12, and >12 months. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis. Results Among 6,729 patients, 425 received DAPT <6 months, 568 for 6–11 months, 2,878 for 12 months, and 2,858 for >12 months. At 800-day follow-up, MACE rates were higher with shorter DAPT (19.5% vs. 10.2% vs. 9.9% vs. 5.9%, p<0.001). Adjusted hazard ratios for MACE were significantly higher for DAPT <6 months (HR 4.8, 95% CI 1.8–12.8), 6–11 months (HR 2.8, 95% CI 1.5–5.0), and 12 months (HR 2.7, 95% CI 1.4–5.0) compared to >12 months (Figure 1, Table 1). This trend was consistent in acute coronary syndrome (ACS) patients but not in stable patients. Conclusion In PCI-treated bifurcation lesions, particularly in ACS patients, shorter DAPT duration is associated with a higher risk of adverse events. These findings highlight the need to consider bifurcation lesions as a key factor in tailoring DAPT duration.Figure 1 Table 1