One-Year Outcomes of Short-Term Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention With Drug-Eluting Stents: A Meta-Analysis of Randomized Clinical Trials.

Abstract

Dual antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention (PCI), though the optimal duration is unclear. DAPT reduces stent thrombosis, repeat myocardial infarction, and cardiovascular death, though at the cost of increased bleeding events. Currently, both European and American guidelines recommend a 6-month duration of DAPT following PCI with drug-eluting stents (DES) for stable coronary disease and a 12-month regimen following PCI for acute coronary syndrome. Recent randomized clinical trials (RCTs) suggest a shorter duration of DAPT may be acceptable. PubMed, EMBASE, and Cochrane databases were queried from inception to June 2025 to identify RCTs comparing short ( ≤ 3 months) with traditional durations of DAPT following PCI with DES and reporting outcomes of interest at 1 year, including major adverse cardiovascular and cerebrovascular events (MACCE) and net adverse clinical events (NACE). Individual endpoints including mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, significant bleeding, and target vessel revascularization were analyzed. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals. Thirteen studies met the inclusion criteria, reporting results on 53,421 patients, of whom 26,712 patients were in the short DAPT cohort and 26,719 in the traditional DAPT cohort. Duration of DAPT ranged from 1 to 3 months. Ten studies used P2Y12 inhibitors as the single antiplatelet agent following DAPT, whereas three studies used aspirin. Patients were 76.0% male, mean age 64.0 years, and 64.9% with ACS on presentation. Shorter duration of DAPT significantly decreased NACE (RR: 0.80; [0.71, 0.91], p < 0.001) without impacting MACE (RR: 0.98; [0.89, 1.07], p = 0.64) at 1 year following PCI with DES. A 3-month duration of DAPT demonstrated favorable results over shorter durations, and monotherapy with a high-potency P2Y12 inhibitor was preferable over aspirin or a low-potency P2Y12 inhibitor. In patients who underwent a PCI with DES placement, a 3-month duration of DAPT decreased NACE without impacting other MACCE compared to guideline-directed DAPT durations.