Key result
Three-month DAPT cuts net adverse clinical events ~19% vs 12-month DAPT, driven by less bleeding.
Why the study?
The optimal duration of dual antiplatelet therapy after ACS treated with PCI remains uncertain due to advances in stent design and potent P2Y12 inhibitors reducing thrombotic risk.
Does 3-month DAPT reduce MACCE and clinically relevant bleeding compared to 12-month DAPT in ACS patients undergoing PCI?
Meta-Analysis
Does 3-month DAPT reduce MACCE and clinically relevant bleeding compared to 12-month DAPT in ACS patients undergoing PCI?
Absolute Risk Reduction: 1.9%
Number Needed to Treat: 52
In ACS patients treated with contemporary DES, a 3-month DAPT strategy followed by monotherapy safely reduces bleeding and net adverse clinical events without increasing ischemic risk compared to standard 12-month DAPT.
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) remains uncertain. Advances in stent design and the use of potent P2Y₁₂ inhibitors have reduced thrombotic risk, raising questions about whether prolonged DAPT continues to provide incremental benefit. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) enrolling exclusively ACS patients undergoing PCI who were randomized to 3-month versus 12-month DAPT. Coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB). Secondary outcomes included all-cause mortality, myocardial infarction, stroke, stent thrombosis, target-vessel revascularization, and net adverse clinical events (NACE; MACCE + CRB). Trial sequential analysis (TSA) was performed to evaluate the conclusiveness of evidence for each coprimary outcome. RESULTS: = 31%), corresponding to an absolute risk reduction of 1.9% and number needed to treat of 52. NACE was lower with abbreviated therapy (7.9% vs 9.7%; RR, 0.81; 95% CI, 0.66-1.00). TSA crossed the futility boundary for MACCE and the benefit boundary for CRB, indicating conclusive evidence for bleeding reduction and futility for ischemic benefit. CONCLUSIONS: Among ACS patients treated with contemporary DES, 3-month DAPT followed by monotherapy significantly reduces bleeding without increasing ischemic events. TSA confirms the conclusiveness of current evidence, supporting abbreviated DAPT as a safe and effective default strategy in appropriately selected ACS patients. REGISTRATION: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with unique identifier CRD420251143351 and URL: https://www.crd.york.ac.uk/prospero/search.
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Chinnatambi et al. (2026) conducted a meta-analysis in Acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). 3-month dual antiplatelet therapy (DAPT) vs. 12-month DAPT was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB). Three-month DAPT reduced net adverse clinical events compared to 12-month DAPT (7.9% vs 9.7%; RR 0.81; 95% CI 0.66-1.00) and significantly reduced bleeding without increasing ischemic events.
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