Personalized DAPT duration (3-24 months) based on a clinical risk score reduced 24-month net adverse clinical events compared to standard 12-month DAPT (18.6% vs 22.2%; P=0.040).
RCT (n=2,107)
Does a personalized duration of dual antiplatelet therapy reduce net adverse clinical events compared to standard 12-month therapy in patients undergoing percutaneous coronary intervention?
A personalized DAPT duration based on a clinical risk score significantly reduced net adverse clinical events compared to standard 12-month DAPT in patients undergoing PCI.
Effect estimate: difference 3.54 percentage points (95% CI -6.99 to -0.99)
Absolute Event Rate: 18.6% vs 22.2%
Absolute Risk Reduction: 3.54%
p-value: p=0.040
BACKGROUND Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain. OBJECTIVES We performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3-, 6-, or 24-months with a standard duration of DAPT for 12 months after PCI. METHODS We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary end point was a net adverse clinical end point (NACE) at 24-months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium (BARC) criteria. The trial was registered in ClinicalTrials.gov (NCT04135989) RESULTS: At 24-months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points, 95% confidence interval CI, -6.99 to -0.99; P=0.040). This difference was mainly related to decreased rates of myocardial infarction (difference, -2.29 percentage points, 95% CI, -4.43 to -0.14) and urgent target-vessel revascularization (difference, -1.30 percentage points, 95% CI, -2.55 to -0.05). Bleeding occurred at similar rates between the two groups (difference, -0.41 percentage points; 95% confidence interval CI, -2.92 to 2.10). CONCLUSIONS In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of net adverse clinical events than standard care consisting of 12 months of DAPT.
“In an almost all-comer PCI population, a personalised DAPT duration, gradually extended from three to 24 months based on the DAPT score, was superior to a standard 12-month approach in terms of net clinical benefit.”
Piccolo et al. (Sat,) conducted a rct in Percutaneous coronary intervention (PCI) (n=2,107). Personalized duration of DAPT (3, 6, or 24 months based on a risk score) vs. Standard duration of DAPT for 12 months was evaluated on Net adverse clinical end point (NACE) at 24-months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization, or type 2, 3, or 5 bleeding according to BARC criteria (difference 3.54 percentage points, 95% CI -6.99 to -0.99, p=0.040). Personalized DAPT duration (3-24 months) based on a clinical risk score reduced 24-month net adverse clinical events compared to standard 12-month DAPT (18.6% vs 22.2%; P=0.040).