Key result
DAPT-OCT trial design launched to evaluate DAPT de-escalation on 12-month neointimal thickness in STEMI.
Why the study?
It is unclear whether DAPT de-escalation after OCT- or angiography-guided PCI improves neointimal coverage in STEMI patients who completed 1-month DAPT with aspirin plus ticagrelor.
Does DAPT de-escalation to aspirin plus clopidogrel improve stent-strut neointimal thickness by OCT assessment at 12 months in STEMI patients after OCT- or angiography-guided PCI?
RCT (n=80)
Open-label
1:1
Does DAPT de-escalation to aspirin plus clopidogrel improve stent-strut neointimal thickness by OCT assessment at 12 months in STEMI patients after OCT- or angiography-guided PCI?
This rationale and design paper outlines a randomized trial evaluating the impact of DAPT de-escalation to clopidogrel on OCT-assessed stent neointimal coverage in STEMI patients.
Background: Dual antiplatelet therapy (DAPT) de-escalation strategies including early switching from a potent P2Y 12 inhibitor to clopidogrel become attractive for patients with ST-elevation Myocardial Infarction (STEMI). It is unclear whether DAPT de-escalation after optical coherence tomography (OCT)- or angiography-guided percutaneous coronary intervention (PCI) improves neointimal coverage in STEMI patients who have completed 1-month DAPT with aspirin plus ticagrelor. Methods: This report describes the design of a randomized study evaluating the neointimal coverage in STEMI patients after guiding de-escalation of DAPT from aspirin plus ticagrelor to aspirin plus clopidogrel at 1 month after PCI with drug eluting stent implantation by OCT or angiography and 1-month DAPT with aspirin plus ticagrelor. Eighty patients who meet the inclusion criteria and none of the exclusion criteria will be randomly assigned in a 1:1 fashion to the OCT- or angiography-guided group (first randomization). All patients will receive open label ticagrelor plus aspirin for 1 month after the index PCI. At 30 ± 7 days after the index PCI, patients with no major adverse cardiovascular and cerebrovascular events (MACCE) or major bleeding (⩾Bleeding Academic Research Consortium [BARC] 3a) will be randomized in a 1:1 fashion to either the ticagrelor plus aspirin group or clopidogrel plus aspirin group for an additional 11 months (second randomization). The primary endpoint is the stent-strut neointimal thickness by OCT assessment at 12-month follow up. Discussion: The data obtained from DAPT-OCT study will explore the neointimal coverage after guiding de-escalation of antiplatelet treatment in STEMI patients undergoing PCI by OCT. Trial registration: ClinicalTrials.gov identifier: NCT06339021.
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Li et al. (2026) conducted an RCT in ST-elevation Myocardial Infarction (STEMI) (n=80). OCT-guided PCI and DAPT de-escalation to aspirin plus clopidogrel vs. Angiography-guided PCI and continued DAPT with aspirin plus ticagrelor was evaluated on Stent-strut neointimal thickness by OCT assessment at 12-month follow up. This report describes the rationale and design of the DAPT-OCT study, which plans to enroll 80 STEMI patients to evaluate neointimal thickness at 12 months following DAPT de-escalation.
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