Impact of one-month DAPT followed by aspirin monotherapy in patients undergoing percutaneous coronary intervention according to clinical presentation: a post hoc analysis of the randomised One-Month DAPT trial

DOI: 10.4244/EIJ-D-22-00135

Yong-Joon Lee
Yong-Joon Lee1, MD; Jae Young Cho2, MD; Kyeong Ho Yun2, MD; Seung-Jun Lee1, MD; Sung-Jin Hong1, MD; Chul-Min Ahn1, MD; Byeong-Keuk Kim1, MD; Young-Guk Ko1, MD; Donghoon Choi1, MD; Myeong-Ki Hong1, MD; Yangsoo Jang3, MD; Jung-Sun Kim1, MD
1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea; 2. Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, South Korea; 3. Department of Cardiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea

Background: The impact of 1-month dual antiplatelet therapy (DAPT) followed by aspirin monotherapy according to clinical presentation has not been elucidated.

Aims: This study aimed to compare the impact of 1-month DAPT followed by aspirin monotherapy after polymer-free drug-coated stent (PF-DCS) implantation (1-month DAPT after PF-DCS) vs 6-12-month DAPT followed by aspirin monotherapy after biodegradable polymer drug-eluting stent (BP-DES) implantation (6-12-month DAPT after BP-DES) according to clinical presentation.

Methods: This is a post hoc analysis of the One-Month DAPT trial. The primary outcome was the composite of major adverse cardiac and cerebrovascular events (MACCE; a composite of cardiac death, non-fatal myocardial infarction, target vessel revascularisation, and stroke) and major bleeding.

Results: Among 1,828 patients with stable coronary artery disease (CAD), 1-month DAPT after PF-DCS resulted in lower rates of the primary outcome than 6-12-month DAPT after BP-DES (3.9% vs 6.5%; hazard ratio [HR] 0.59, 95% confidence interval [CI]: 0.39–0.90; p=0.012). However, among 1,192 patients with acute coronary syndrome (ACS), the rates of primary outcome were not significantly different between the two therapy groups (5.6% vs 3.6%; HR 1.57, 95% CI: 0.91–2.70; p=0.102) and a significant interaction was observed between therapy and clinical presentation regarding primary outcome (Pint=0.005). A significant interaction was observed in MACCE (Pint=0.016), but not in major bleeding (Pint=0.276).

Conclusions: In patients undergoing drug-eluting stent implantation for non-complex lesions, the benefits of 1-month DAPT followed by aspirin monotherapy for a composite of ischaemic and bleeding outcomes were found in patients with stable CAD, but not in those with ACS. ClinicalTrials.gov: NCT02513810.

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acs/nste-acsadjunctive pharmacotherapydrug-eluting stentstable angina
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