Prepared by: Dr. Serkan Bulguroğlu

Name of the Study: Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis

Published in Congress: EURO PCR 2025

Link https://doi.org/10.1093/eurheartj/ehac284

Introduction
In patients undergoing complex percutaneous coronary intervention (PCI), prolonged dual antiplatelet therapy (DAPT) may reduce ischaemic events in those without high bleeding risk but increases bleeding risk across all groups. The MASTER DAPT trial showed that in high bleeding risk patients, 1-month DAPT was as effective as longer therapy with less bleeding, and this analysis examined whether these effects were consistent across different levels of patient and procedural complexity.

Objective
To assess the effects of 1- or ?3-month DAPT in high bleeding risk (HBR) patients who received biodegradable-polymer sirolimus-eluting stents for complex PCI and/or acute coronary syndrome (ACS).

Methods
In the MASTER DAPT trial, 3383 patients underwent non-complex (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 complex (abbreviated DAPT, n = 588; standard DAPT, n = 608) PCI. Co-primary outcomes at 335 days were net adverse clinical events [NACE; composite of all-cause death, myocardial infarction, stroke, and bleeding academic research consortium (BARC) 3 or 5 bleeding events]; major adverse cardiac or cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and Types 2, 3, or 5 BARC bleeding.

Results
Net adverse clinical events and MACCE did not differ with abbreviated vs. standard DAPT among patients with complex [hazard ratio (HR): 1.03, 95% confidence interval (CI): 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively] and non-complex PCI (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; Pinteraction = 0.60 and 0.26, respectively). BARC 2, 3, or 5 was reduced with abbreviated DAPT in patients with and without complex PCI (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55-0.89; Pinteraction = 0.72). Among the 2816 patients with complex PCI and/or ACS, NACE and MACCE did not differ and BARC 2, 3, or 5 was lower with abbreviated DAPT.

Conclusions
In HBR patients free from recurrent ischaemic events at 1 month, DAPT discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity.

Commentary
In HBR patients who underwent complex or non-complex PCI with biodegradable-polymer sirolimus-eluting stent implantation and did not encounter early recurrent ischaemic events, the discontinuation of DAPT a median of 34 days after PCI, compared with continuation of treatment for a median duration of 193 days, was consistently associated with similar rates of NACE and MACCE and a lower rate of major or clinically relevant non-major bleeding.