Key result
Shortened DAPT matches standard duration for safety and efficacy after new-generation DES.
Why the study?
The optimal duration of dual antiplatelet therapy after implantation of new generation drug-eluting stents remains uncertain given advances in stent technology and the need to balance stent thrombosis prevention with systemic cardiovascular risk.
Does shortened dual antiplatelet therapy provide non-inferior safety and efficacy compared to standard duration in patients undergoing percutaneous coronary intervention with new generation drug-eluting stents?
Does shortened dual antiplatelet therapy provide non-inferior safety and efficacy compared to standard duration in patients undergoing percutaneous coronary intervention with new generation drug-eluting stents?
Shortened DAPT regimens with newer generation drug-eluting stents show non-inferior safety and efficacy, but must be balanced against the need for secondary prevention in high-risk populations.
Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy (DAPT) to reduce stent thrombosis and avoid target lesion failure. The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome, and 6 mo for patients with chronic coronary syndrome or high bleeding risk. The new generation of drug-eluting stents have metallic platforms with thinner struts, associated with significantly less stent thrombosis. Shortened DAPT has been investigated with these stents, with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes. This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations. This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.
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Han et al. (2021) conducted a review in Acute coronary syndrome and chronic coronary syndrome. Shortened dual antiplatelet therapy (DAPT) was evaluated. Shortened dual antiplatelet therapy with new generation drug-eluting stents shows non-inferior safety and efficacy outcomes in some randomized clinical trials.
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