The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Final results of the Randomised Evaluation of short-term DUal antiplatelet therapy in patients with acute Coronary syndromE treated with a new generation stent (REDUCE) trial

DOI: 10.4244/EIJ-D-19-00539

1. AOU Maggiore della Carita, Eastern Piedmont University, Novara, Italy, Italy
2. Radboud University Medical Center, Nijmegen, The Netherlands
3. Radboud University Medical Center, Nijmegen, The Netherlands
4. Jessa Ziekenhuis, Hasselt, Belgium
5. AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
6. Maastricht University Medical Center, Maastricht, The Netherlands; Zuyderland Atrium Medical Center, Heerlen, The Netherlands
7. Hospital Queen Elizabeth II, Sabah, Malaysia
8. Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
9. University Malaya Medical Centre, Kuala Lumpur, Malaysia
10. National Heart Institute, Kuala Lumpur, Malaysia
11. Diagram B.V., Zwolle, the Netherlands
12. Isala Hospital, Zwolle, The Netherlands
13. Radboud University Medical Center, Nijmegen, The Netherlands
14. AOU Maggiore della Carita, Eastern Piedmont University, Novara, Italy, Italy
15. Queen Mary Hospital, University of Hong Kong, Hong Kong
16. Centre Hospitalier Universitaire, Charleroi, Belgium
17. Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
18. National Heart Centre, Singapore, Singapore
19. Jessa Ziekenhuis, Hasselt, Belgium
20. Jessa Ziekenhuis, Hasselt, Belgium
21. Maastricht University Medical Center, Maastricht, The Netherlands; Zuyderland Atrium Medical Center, Heerlen, The Netherlands
22. Maastricht University Medical Center, Maastricht, The Netherlands; Zuyderland Atrium Medical Center, Heerlen, The Netherlands
23. Isala Hospital, Zwolle, The Netherlands
24. Diagram B.V., Zwolle, the Netherlands
25. Radboud University Medical Center, Nijmegen, The Netherlands
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Aims:. The optimal duration of DAPT in ACS patients treated with DES is still unclear. 

Methods and results:. REDUCE is a prospective, open label, multicenter, investigator-initiated study that randomised 1496 ACS patients after treatment with COMBO to either 3 (n=751) or 12-month (n=745) of DAPT. Primary study endpoint was a composite of all cause mortality, myocardial infarction, stent thrombosis, stroke, target-vessel revascularisation and bleeding at 12 months. No difference was observed in demographic and clinical characteristics between the two groups, except for gender (p=0.01). At 1 year follow-up non-inferiority of 3 vs 12-month DAPT in the primary endpoint was met (8.2%vs8.4%,pnon-inferiority<0.001). The similar outcome between the two groups was confirmed at 2-year follow-up (11.6%vs12.1%,p=0.76), with no significant difference in overall mortality (3.1%vs2.2%,p=0.27), cardiac mortality (1.8%vs1.1%,p=0.28), stent thrombosis (1.6% vs0.8%,p=0.16) and major bleeding (3.3% vs4.0%,p=0.46). 

Conclusions:. The results show that among ACS patients treated with COMBO, 3 months is non-inferior to 12 months DAPT. However, given the numerically higher rates of mortality and ST in the 3 months DAPT group, 1-year DAPT should still be recommended in ACS until more information becomes available. A 3 months DAPT strategy should be considered only if clinically mandated.

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