Key result
Contemporary post-PCI antiplatelet trends show equivalent DAPT duration and ~0.6-point lower 1-year major bleeding.
Why the study?
Despite rapidly evolving evidence supporting risk-tailored antiplatelet strategies after PCI, nationwide data on temporal changes in real-world treatment and clinical outcomes remained limited.
Cohort (n=258,334)
Yes
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
““Taken together, these findings provide a nationwide overview of evolving antiplatelet treatment patterns after PCI, characterized by a shift from extended toward standard-duration DAPT, modest expansion of other bleeding-avoidance strategies, and heterogeneous clinical outcome trends,” said Lee, et al.”
Between 2014 and 2021, real-world antiplatelet strategies after PCI evolved but only partially reflected changing guideline recommendations, accompanied by a significant decline in 1-year major bleeding rates and less uniform reductions in MACE.
Background Despite rapidly evolving evidence supporting risk-tailored antiplatelet strategies after PCI, nationwide data on temporal changes in real-world treatment and clinical outcomes remain limited. Objectives We characterized temporal trends in antiplatelet strategies and clinical outcomes according to clinical presentation and bleeding risk. Methods Using a nationwide claims database, we identified 258,334 patients undergoing PCI between 2014 and 2021. Antiplatelet strategies were evaluated, and DAPT-duration trends were analyzed using Joinpoint regression. Bleeding risk was classified using Academic Research Consortium–High Bleeding Risk criteria. Clinical outcomes included major bleeding and major adverse cardiovascular events (MACE). Results The mean difference in DAPT duration between chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) was 15.5 days (90% confidence interval [CI], 11.1–20.0), within the ±1.5-month equivalence margin (P for equivalence <0.001). Extended DAPT (>6 months beyond the guideline-recommended duration) increased from 2014 to 2016 (annual percent change [APC], 15.2%; 95% CI, 8.2–20.3) and declined from 2016 to 2021 (APC, –2.9%; 95% CI, –4.3 to –1.9), with little corresponding increase in short DAPT (CCS <6 months; ACS <12 months). Potent P2Y12 inhibitor monotherapy remained uncommon; de-escalation increased early, then changed little. The 1-year cumulative incidence of major bleeding decreased from 2.6% (95% CI, 2.5–2.8) in 2014 to 2.0% (95% CI, 1.9–2.1) in 2021 (P for trend <0.001). MACE declined overall, with heterogeneous trends across subgroups. Conclusions Antiplatelet strategies evolved over time, although real-world practice only partially reflected changing guideline recommendations. Major bleeding declined over time, whereas MACE trends were less uniform.
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Lee et al. (2026) conducted a cohort in Patients undergoing percutaneous coronary intervention (PCI) with chronic coronary syndrome (CCS) or acute coronary syndrome (ACS) (n=258,334). Antiplatelet strategies after PCI (2014–2021 temporal trends and presentation/bleeding risk strata) vs. Earlier calendar years (2014 vs 2021) and chronic vs acute coronary syndrome was evaluated on 1-year cumulative incidence of major bleeding and major adverse cardiovascular events (MACE); DAPT duration trends (MD 15.5 days (DAPT duration between CCS and ACS), p=<0.001 for trend (major bleeding); <0.001 for equivalence (DAPT duration)). Post-PCI antiplatelet strategies from 2014 to 2021 showed equivalent DAPT duration between CCS and ACS (MD 15.5 days; P<0.001) and decreased 1-year major bleeding from 2.6% to 2.0% (P<0.001).
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