Extended Dual Versus Single Anti‐Platelet Therapy Following Percutaneous Coronary Intervention: A Bayesian Meta‐Analysis and Regression on All‐Cause Mortality

ABSTRACT Introduction Current ESC/EACTS guidelines recommend standard‐duration dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). However, the subsequent transition to either extended DAPT or single antiplatelet therapy (SAPT) remains debated due to limited comparative outcome data. This Bayesian meta‐analysis and meta‐regression evaluate the clinical safety of DAPT versus SAPT, and the impact of potential confounders on all‐cause mortality. Methods Following PRISMA guidelines, a systematic search of PubMed, Embase, Cochrane Library, ScienceDirect, and Scopus was conducted till April 2025 to identify randomized clinical trials (RCTs) and cohort studies. Primary outcomes were all‐cause mortality and bleeding events. Bayesian random‐effects meta‐analysis was performed using the brms package in R with Markov Chain Monte Carlo sampling and weakly informative priors. Bayesian meta‐regression of log‐transformed odds ratios (OR) assessed associations with relevant covariates. Results Fourteen studies (9 RCTs and 5 cohort studies) comprising 56,572 patients were included. Compared with SAPT, DAPT was associated with increased all‐cause mortality (OR 1.25; 95% credible interval CrI, 1.04–1.51; posterior probability of harm, PrOR > 1 = 84%). DAPT also increased the risk of net adverse clinical events NACE (OR, 1.29; 95% CrI, 1.08–1.53), minor bleeding (OR, 1.60; 95% CrI, 1.10–2.33), major bleeding (OR, 1.70; 95% CrI, 1.30–2.23), and BARC 2–5 bleeding (OR, 1.78; 95% CrI, 1.40–2.26) with Pr OR > 1 >90% for all outcomes. No significant differences were observed in cardiac death, cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), stent thrombosis, or stroke. Meta‐regression revealed that higher baseline odds of dyslipidemia (−0.89), hypertension (−1.19), prior MI (−0.94), and previous revascularization (−0.30) were associated with greater mortality benefit from DAPT. However, in the DAPT cohort, increased odds of adverse events, including cardiac death (0.41), MACCE (0.55), stroke (0.60), MI (0.29), and NACE (0.98), were significantly associated with higher all‐cause mortality. Conclusion Extended DAPT is associated with a higher all‐cause mortality, bleeding events, and NACE. While DAPT may benefit high‐risk populations, the increased odds of adverse events are significantly associated with mortality, warranting that it be carefully considered and monitored in post‐PCI patients.