Key result
Abbreviated DAPT shows no benefit over standard DAPT for net adverse clinical events in bifurcation PCI.
Why the study?
Coronary stenting of bifurcation lesions increases thrombotic risk, but the optimal DAPT duration in high bleeding risk patients undergoing bifurcation PCI remains unknown.
Does abbreviated DAPT reduce bleeding without increasing ischemic events compared to standard DAPT in patients with high bleeding risk undergoing PCI of bifurcation lesions?
RCT (n=4,579)
Does abbreviated DAPT reduce bleeding without increasing ischemic events compared to standard DAPT in patients with high bleeding risk undergoing PCI of bifurcation lesions?
Hazard Ratio: 0.98 (95% CI 0.73–1.17)
In high bleeding risk patients undergoing bifurcation PCI, a 1-month abbreviated DAPT regimen reduces bleeding without increasing ischemic events compared to standard DAPT.
Abbreviated DAPT reduces bleeding without ischemic excess in high-risk bifurcation PCI; extends MASTER DAPT findings to this subgroup.
BACKGROUND: Coronary stenting of bifurcation lesions has been associated with an increased risk of thrombotic events. However, the optimal duration of dual antiplatelet therapy (DAPT) after treatment of bifurcations, particularly among patients with high bleeding risk, is unknown. We aimed to evaluate the safety and efficacy of abbreviated DAPT in patients with high bleeding risk undergoing percutaneous coronary intervention (PCI) of bifurcation lesions. METHODS: The MASTER DAPT trial (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen) randomized patients with high bleeding risk who were free from ischemic or bleeding events after 1 month of PCI to discontinue DAPT (abbreviated regimen) or continue DAPT for a minimum of 2 additional months (standard regimen). Coprimary outcomes were net adverse clinical outcomes events, major adverse cardiac and cerebral events, and BARC (Bleeding Academic Research Consortium) type 2, 3, or 5 bleeding at 335 days after randomization. This prespecified substudy evaluates the outcomes of abbreviated versus standard DAPT according to treatment of bifurcation lesions. RESULTS: Of the 4579 patients randomized, 976 (21.2%) underwent bifurcation PCI. Net adverse clinical event and major adverse cardiac and cerebral events did not differ between abbreviated and standard DAPT in both patients with (hazard ratio [HR], 0.98 [95% CI, 0.73–1.17] and HR, 0.92 [95% CI, 0.63–1.54], respectively) and without bifurcation PCI (HR, 1.14 [95% CI, 0.67–1.93] and HR, 0.96 [95% CI, 0.74–1.25]; P interaction=0.803 and 0.563, respectively). Abbreviated DAPT consistently reduced BARC 2, 3, or 5 bleeding in patients with (HR, 0.83 [95% CI, 0.53–1.30]) or without (HR, 0.65 [95% CI, 0.51–0.82]) bifurcation ( P interaction=0.321). CONCLUSIONS: Among patients with high bleeding risk with or without bifurcation PCI, abbreviated DAPT was associated with lower bleeding risk without an excess of ischemic or net adverse events compared with standard DAPT. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03023020.
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CHEVALIER et al. (2026) conducted an RCT in High bleeding risk undergoing PCI of bifurcation lesions (n=4,579). Abbreviated DAPT vs. Standard DAPT was evaluated on Net adverse clinical outcomes events (HR 0.98, 95% CI 0.73-1.17). Among patients with high bleeding risk undergoing bifurcation PCI, abbreviated DAPT did not significantly differ from standard DAPT for net adverse clinical events (HR 0.98; 95% CI 0.73-1.17).
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