Key result
Short-term DAPT linked to ~79% higher MACE risk vs. long-term DAPT in bifurcation lesions.
Why the study?
The optimal duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions remains uncertain.
Does short-term dual antiplatelet therapy (≤6 months) increase major adverse cardiovascular events compared to long-term therapy (>6 months) in patients undergoing percutaneous coronary intervention for bifurcation lesions?
Meta-Analysis (n=12,066)
Does short-term dual antiplatelet therapy (≤6 months) increase major adverse cardiovascular events compared to long-term therapy (>6 months) in patients undergoing percutaneous coronary intervention for bifurcation lesions?
Effect estimate: RR 1.79 (95% CI 1.05-3.07)
In patients undergoing PCI for bifurcation lesions, short-term DAPT (≤6 months) is associated with significantly worse ischemic outcomes compared to long-term DAPT (>6 months), supporting extended DAPT in this high-risk subgroup.
May warrant longer DAPT in appropriate patients; challenges consensus favoring short-term regimens.
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions remains uncertain. This meta-analysis focused on comparing ischemic and bleeding outcomes between short-term (≤6 months) and long-term (>6 months) DAPT in this high-risk subgroup. METHODS: We included six studies comprising 12 066 patients with bifurcation lesions treated with drug-eluting stents and either short- or long-term DAPT. Pooled relative risk (RR) and 95% confidence intervals (CI) were calculated for major adverse cardiovascular events (MACE), all-cause and cardiac mortality, myocardial infarction, stent thrombosis, stroke, bleeding, and target lesion revascularization. RESULTS: Short-term DAPT was associated with significantly higher risks of MACE (RR 1.79; 95% CI 1.05-3.07), all-cause mortality (RR: 2.78; 95% CI: 1.49-5.19), cardiac death (RR 2.29; 95% CI 1.34-3.91), and stent thrombosis (RR: 4.90; 95% CI: 2.78-8.66). Although the risks of myocardial infarction (RR: 1.75; 95% CI: 0.69-4.47), stroke (RR: 1.07; 95% CI: 0.61-1.67), bleeding (RR: 1.49; 95% CI: 0.24-9.48), and target lesion revascularization (RR: 1.35; 95% CI: 0.85-2.12) did not reach statistical significance, the effect estimates consistently favored long-term DAPT. CONCLUSION: In patients undergoing percutaneous coronary intervention for bifurcation lesions, short-term DAPT was associated with significantly worse ischemic outcomes, including increased rates of MACE, death, and stent thrombosis. These findings support the use of extended DAPT duration as the preferred strategy in this anatomical subgroup, with treatment tailored according to individual bleeding risk.
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Suruagy-Motta et al. (2026) conducted a meta-analysis in coronary bifurcation lesions undergoing percutaneous coronary intervention (n=12,066). Short-term DAPT vs. Long-term DAPT was evaluated on major adverse cardiovascular events (MACE) (RR 1.79, 95% CI 1.05-3.07). Short-term DAPT (≤6 months) was associated with a significantly higher risk of MACE compared to long-term DAPT (>6 months) in patients with bifurcation lesions (RR 1.79; 95% CI 1.05-3.07).
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