The DAPT-MVD (Dual Antiplatelet Therapy in Patients With Coronary Multi-Vessel Disease) trial was a multicenter, randomized, open-label study in China designed to assess whether extending dual antiplatelet therapy (DAPT) beyond 12 months provides additional benefit for patients with multivessel coronary artery disease (CAD) following percutaneous coronary intervention (PCI).¹ In total, 8,250 patients who had completed 12 months of aspirin plus clopidogrel without ischemic or major bleeding events were randomly assigned in a 1:1 ratio to receive either extended DAPT for an additional year or aspirin monotherapy. The primary endpoint was the incidence of major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, or stroke) at 36 months.

MACE occurred in 5.8% of patients receiving extended DAPT and in 6.8% receiving aspirin alone (hazard ratio, 0.82; 95% confidence interval, 0.69-0.98; p = 0.03). Major bleeding was similar between groups. These findings indicate that prolonged platelet inhibition offers modest but meaningful protection when treatment tolerance and a low bleeding risk are present. Previous meta-analyses in contemporary PCI practice have demonstrated limited benefit of DAPT beyond 12 months in populations at lower risk.² More recent randomized controlled trials evaluating shorter DAPT durations have demonstrated reductions in bleeding without an excess risk of stent thrombosis.³ However, evidence for stable patients with diffuse CAD has been scarce. The DAPT-MVD trial findings therefore provide needed randomized data supporting prolonged therapy specifically in patients with stable multivessel disease, a population underrepresented in prior studies.

The DAPT-MVD trial findings support individualized antiplatelet strategies. For patients with stable multivessel disease and low bleeding risk, extending DAPT beyond 1 year may be considered to reduce recurrent ischemic events. Study limitations included the relatively young East Asian cohort, which may limit global generalizability; the open-label design, despite blinded outcome adjudication; the exclusive use of clopidogrel, which differs from current acute coronary syndrome practice that favors more potent P2Y12 inhibitors; and the exclusion of patients with early ischemic or bleeding events.

References

1. Tian J, Wang Z, Wang Y, et al. Rationale and design of Dual Antiplatelet Therapy in Patients with Coronary Multi-Vessel Disease (DAPT-MVD): a multicenter, randomized, controlled trial. Clin Cardiol. 2024;47(12):e70049. doi:10.1002/clc.70049
2. Li J, He K, Ge J, Li C, Jing Z. Short-term vs long-term dual antiplatelet therapy after drug-eluting stent implantation in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Int J Clin Pract. 2021;75(7):e13938. doi:10.1111/ijcp.13938
3. Bajraktari G, Bytyçi I, Abdyli G, et al. One-month dual antiplatelet therapy reduces major bleeding compared with longer-term treatment without excess stent thrombosis: a systematic review and meta-analysis of randomized clinical trials. Am J Cardiol. 2024;227:91-97. doi:10.1016/j.amjcard.2024.07.010