Findings from the DUAL-ACS trial presented at ESC Congress 2025 suggest that three months of dual antiplatelet therapy (DAPT) following an acute myocardial infarction (MI) has the potential for better survival and lower bleeding rates compared with 12 months of DAPT.

Researchers randomized approximately 5,000 patients from Scotland, England and New Zealand to either 3 months or 12 months of DAPT. The real-world population of patients had experienced a type 1 MI within 12 weeks and had been treated with stents, bypass grafting or medical therapy alone.

After a 15-month follow-up period, the primary endpoint of all-cause mortality occurred in 2.7% of patients assigned to 3-month DAPT compared with 3.4% of patients assigned to 12-month DAPT. No difference in cardiovascular death or nonfatal MI was observed. Fatal and nonfatal major bleeding occurred in 3.2% of patients in the 3-month DAPT group and 4.0% of patients in the 12-month DAPT group.

"This all-comer real-world trial recruited only 30% of the planned participants and was unable to address the primary question definitively. However, there was no evidence that DAPT given for 12 months conferred any additional benefit," said Principal Investigator David Newby, MD, FACC. "Indeed, the trends for lower mortality and bleeding risk with 3 months of DAPT are consistent with prior meta-analyses and suggest that limiting DAPT duration to 3 months may be safer in a real-world contemporary population."