Association between short (≤ 30-day) dual antiplatelet therapy and 1-year major adverse cardiac events after drug-coated balloon–based non-stent percutaneous coronary intervention following optimal lesion preparation: a propensity score–based cohort study

Drug-coated balloon (DCB)-based non-stent percutaneous coronary intervention (PCI) may allow shorter dual antiplatelet therapy (DAPT), but whether a ≤ 30-day regimen is associated with worse outcomes remains unclear, particularly in patients not receiving oral anticoagulants. We conducted a single-center retrospective cohort study of patients undergoing DCB-based non-stent PCI between April 2021 and December 2024. Patients receiving oral anticoagulants were excluded. Patients were classified into short DAPT (≤ 30 days; n = 153) or standard DAPT (> 30 days; n = 184). All procedures were performed after optimal lesion preparation, frequently including debulking devices. The primary endpoint was 1-year major adverse cardiac events (MACE). Propensity score-based analyses and Kaplan-Meier methods were applied to evaluate time-to-event outcomes. A total of 337 patients were included. MACE occurred in 9/153 (5.9%) patients in the short-DAPT group and 12/184 (6.5%) in the standard-DAPT group. In unadjusted analyses, there was no significant difference between groups (OR 0.90, 95% CI 0.37-2.21). After adjustment, short DAPT was not associated with 1-year MACE (IPTW OR 0.97, 95% CI 0.40-2.32; SMRW OR 0.88, 95% CI 0.35-2.23). In the matched cohort (112 pairs), findings were consistent (OR 1.54, 95% CI 0.53-4.49). Kaplan-Meier analysis showed no significant difference between groups (log-rank p = 0.78), with no apparent early divergence between the curves. Short DAPT after DCB-based non-stent PCI in patients not receiving oral anticoagulants was not statistically associated with increased 1-year MACE. These findings should be interpreted cautiously given the observational design and potential residual confounding.