Key result
Abbreviated DAPT following DCB-only PCI in acute coronary syndromes was not associated with a significant difference in NACE compared to standard DAPT (HR 1.29; 95% CI 0.81-2.03; p=0.28).
Why the study?
The absence of stent implantation when using DCBs may decrease the required duration of DAPT, but outcomes with abbreviated versus standard DAPT after DCB-only PCI in ACS needed evaluation.
Does abbreviated DAPT improve net adverse clinical events in patients with acute coronary syndromes treated with DCB-only PCI compared to standard DAPT?
Observational (n=1,128)
Yes
Does abbreviated DAPT improve net adverse clinical events in patients with acute coronary syndromes treated with DCB-only PCI compared to standard DAPT?
Answers are grounded in this paper and cite their sources.
Abbreviated DAPT after DCB-only PCI in ACS showed no statistically significant difference in NACE compared to standard DAPT, but wide confidence intervals suggest more evidence is needed before routine adoption.
AIMS: The absence of stent implantation when using drug-coated balloons (DCB) may decrease the required duration of dual antiplatelet therapy (DAPT). In the light of this, this study aimed to evaluate outcomes for patients with acute coronary syndromes treated with abbreviated versus standard DAPT after DCB-only PCI. METHODS AND RESULTS: Patients enrolled in the SWEDEHEART registry between June 2013 and February 2022, treated exclusively with DCBs for ACS, were included. Only patients discharged with ticagrelor as P2Y12-inhibition were included. Patients were categorized by intended DAPT duration at discharge. The primary outcome was net adverse clinical events (NACE) at one year from discharge date, defined as the first occurrence of all-cause death, stroke, myocardial infarction, or major bleeding. The primary analysis used inverse-probability-of-treatment-weighted (IPTW) Cox regression. Among 1,128 patients (141 abbreviated DAPT, 986 standard DAPT), NACE occurred in 25 patients (crude 17.7%; weighted 17.8%) in the abbreviated-DAPT arm and 133 patients (crude 13.5%; weighted 13.8%) in the standard-DAPT arm, corresponding to a weighted hazard ratio of 1.29 (95% CI 0.81-2.03; p=0.28). Results were consistent across pre-specified sensitivity analyses. Due to the small sample size, variance was generally high. CONCLUSION: In this nationwide registry-based analysis, abbreviated DAPT following DCB-only PCI in ACS was not associated with a statistically significant difference in NACE. However, the confidence intervals were wide and did not exclude clinically meaningful harm. The findings should be regarded as hypothesis-generating and indicate the need for more comprehensive evidence before abbreviated DAPT is routinely adopted in this setting.
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Hakansson et al. (2026) conducted an observational in Acute coronary syndromes (n=1,128). Abbreviated DAPT vs. Standard DAPT was evaluated on Net adverse clinical events (NACE) at one year (all-cause death, stroke, myocardial infarction, or major bleeding) (HR 1.29, 95% CI 0.81-2.03, p=0.28). Abbreviated DAPT following DCB-only PCI in acute coronary syndromes was not associated with a significant difference in NACE compared to standard DAPT (HR 1.29; 95% CI 0.81-2.03; p=0.28).
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