Key result
Extended DAPT after CTO-PCI cuts MACE ~32% vs short-term DAPT, but increases bleeding.
Why the study?
Chronic total occlusion PCI carries substantial ischemic risk, yet the optimal duration of DAPT after successful CTO-PCI with drug-eluting stent implantation remains uncertain.
Does extended dual antiplatelet therapy (>12 months) reduce major adverse cardiovascular events compared to short-term dual antiplatelet therapy (≤12 months) in adult patients undergoing successful chronic total occlusion percutaneous coronary intervention with drug-eluting stent implantation?
Meta-Analysis (n=3,362)
Does extended dual antiplatelet therapy (>12 months) reduce major adverse cardiovascular events compared to short-term dual antiplatelet therapy (≤12 months) in adult patients undergoing successful chronic total occlusion percutaneous coronary intervention with drug-eluting stent implantation?
In patients undergoing successful CTO-PCI with drug-eluting stents, extending DAPT beyond 12 months reduces major adverse cardiovascular events at the expense of increased total bleeding compared with DAPT for 12 months or less.
Individualized antiplatelet duration remains necessary after CTO-PCI; leaves open whether extended DAPT beyond 12 months improves net clinical benefit pending dedicated randomized trials.
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with substantial ischemic risk, yet the optimal duration of dual antiplatelet therapy (DAPT) after successful CTO-PCI remains uncertain. We conducted a systematic review and meta-analysis comparing extended DAPT (>12 months) with short-term DAPT (≤12 months) following CTO-PCI. Four electronic biomedical databases were searched from inception to September 2026. Comparative studies evaluating adult patients undergoing successful CTO-PCI with drug-eluting stent implantation were eligible. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Three retrospective cohort studies including 3362 patients were identified, with 1761 receiving extended DAPT and 1601 receiving short-term DAPT. Extended DAPT was associated with a significantly lower risk of major adverse cardiovascular events compared with short-term DAPT (RR 0.68; 95% CI 0.55-0.84; P = 0.0004). There was no significant difference in all-cause death (RR 0.25; 95% CI 0.04-1.41; P = 0.116), myocardial infarction, stroke, cardiovascular death, major bleeding, or revascularization outcomes. However, extended DAPT was associated with a significantly higher risk of total bleeding (RR 2.34; 95% CI 1.31-4.20; P = 0.0043). Among patients undergoing successful CTO-PCI, extended DAPT was associated with lower major adverse cardiovascular events but increased total bleeding compared with DAPT ≤12 months.
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Emara et al. (2026) conducted a meta-analysis in Chronic total occlusion undergoing percutaneous coronary intervention (n=3,362). Extended dual antiplatelet therapy (>12 months) vs. Short-term dual antiplatelet therapy (≤12 months) was evaluated on Major adverse cardiovascular events (RR 0.68, 95% CI 0.55-0.84, p=0.0004). Extended DAPT (>12 months) after CTO-PCI was associated with lower major adverse cardiovascular events (RR 0.68; 95% CI 0.55-0.84) but higher total bleeding (RR 2.34) versus short-term DAPT.
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