Log in to MyACC
Short DAPT Duration After Coronary Stenting for MI
Quick Takes
- Abbreviated DAPT (DAPT discontinued at 30 days and single APT [SAPT] continued for 11 months; SAPT continued for 5 months only if on oral anticoagulant) was associated with equivalent ischemic outcomes compared to nonabbreviated regimen (DAPT for a minimum 3 months) among patients with recent MI.
- Abbreviated duration of DAPT was associated with significantly less bleeding.
- Although trial results provide reassurance about shorter DAPT duration among acute or recent MI patients, results are specific to patients with “high bleeding risk” (and how that was defined in the trial) and to patients undergoing stenting using bioabsorbable polymer stents.
Study Questions:
What is the optimal duration of antiplatelet therapy (APT) after coronary stenting in patients at high bleeding risk presenting with an acute coronary syndrome?
Methods:
Patients at high bleeding risk were enrolled in the MASTER DAPT (n = 4,579) trial and were randomized after 1 month of dual APT (DAPT) to abbreviated (DAPT stopped and 11 months; single APT or 5 months in patients on oral anticoagulant) or nonabbreviated APT (DAPT for minimum 3 months) strategies. Randomization was stratified by acute or recent myocardial infarction (MI) at index procedure. Coprimary outcomes at 335 days after randomization were: net adverse clinical outcome events (NACE), major adverse cardiac and cerebral events (MACCE) and type 2, 3, or 5 Bleeding Academic Research Consortium (BARC) bleeding.
Results:
NACE and MACCE did not differ with abbreviated versus nonabbreviated APT regimens in patients with an acute or recent MI (n = 1,780; hazard ratio [HR], 0.83 [95% CI, 0.61−1.12] and 0.86 [0.62−1.19], respectively) or without an acute or recent MI (n = 2,799; HR, 1.03 [95% CI, 0.77−1.38] and 1.13 [0.80−1.59]; p for interaction = 0.31 and 0.25, respectively). BARC 2, 3, or 5 bleeding was significantly reduced in patients with or without an acute or recent MI (HR, 0.65 [0.46−0.91] and 0.71 [0.54−0.92]; p for interaction = 0.72) with abbreviated APT.
Conclusions:
The investigators concluded that a 1-month DAPT strategy in high bleeding risk patients presenting with an acute or recent MI results in similar NACE and MACCE rates and reduces bleeding compared with a nonabbreviated DAPT strategy.
Perspective:
The MASTER DAPT trial was designed to investigate the safety of abbreviated versus nonabbreviated APT in patients at high risk for bleeding and undergoing coronary stenting. This was a planned subgroup analysis comparing patients with and without recent MI. Abbreviated DAPT (DAPT discontinued at 30 days and SAPT continued for 11 months; SAPT continued for 5 months only if on oral anticoagulant) was associated with equivalent ischemic clinical outcomes compared to nonabbreviated regimen (DAPT for a minimum 3 months). In addition, shorter duration of DAPT was associated with significantly less bleeding. Though trial results provide reassurance about shorter DAPT duration among acute or recent MI patients, results are specific to patients with ‘high bleeding risk’ (and how that was defined in the trial) and to patients undergoing stenting using bioabsorbable polymer stents.
Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and ACS, Interventions and ACS
Keywords: Absorbable Implants, Acute Coronary Syndrome, Anticoagulants, Drug-Eluting Stents, Hemorrhage, Myocardial Infarction, Myocardial Ischemia, Outcome Assessment, Health Care, Platelet Aggregation Inhibitors, Polymers, Risk, Stents
< Back to Listings
