RCT | 3-6 month DAPT noninferior to 12 month DAPT in patients undergoing PCI with third-generation DES

Summary: In a randomized trial involving 2,013 patients across 37 centers in South Korea, researchers compared the effectiveness of 3-6 month dual antiplatelet therapy (DAPT) versus 12 months of DAPT after percutaneous coronary intervention (PCI) using third-generation drug-eluting stents.

The primary outcome was net adverse clinical events (NACE), a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, or major bleeding.

The study found that 3-6 month DAPT was non-inferior to 12-month DAPT for NACE (3.7% vs. 4.1%, respectively), with a consistent treatment effect across various subgroups. No significant differences were observed in target lesion failure or major bleeding between the two groups.

Despite these findings, further research is needed to generalize the results to other populations and to determine the ideal regimen for 3-6 month DAPT.

Article: Comparison Of 3-6 Month Versus 12 Month Dual Antiplatelet Therapy After Coronary Intervention Using the Contemporary Drug-eluting Stents With Ultrathin Struts: The HOST-IDEA Randomized Clinical Trial – Circulation (link to abstract – $ for full-text)

Commentary: Short DAPT Noninferior to 1 Year After Ultrathin DES PCI: HOST-IDEA – TCTMD

Related:

Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes – JACC: Cardiovascular Interventions

Long-term Effects of P2Y12 Inhibitor Monotherapy After Percutaneous Coronary Intervention: 3-Year Follow-up of the SMART-CHOICE Randomized Clinical Trial – JAMA Cardiology (link to abstract – $ for full-text)

Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT-2 Randomized Clinical Trial – JAMA

Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention: The SMART-CHOICE Randomized Clinical Trial – JAMA

Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial – JAMA Cardiology

Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial – The BMJ

6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial – The Lancet

Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting – Journal of the American College of Cardiology

Commentary on Twitter

#OriginalResearch simpub #CircACC23: The HOST-IDEA RCT showed DAPT duration of 3-6mo was non-inferior to 12mo for net adverse clinical events in patients undergoing PCI with 3rd-gen DES @drlsj https://t.co/uD8RKc03Ci pic.twitter.com/DXPvoyiNke

— Circulation (@CircAHA) March 5, 2023