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Background <p>Patients undergoing complex percutaneous coronary intervention (PCI) have a higher risk of ischemic events and often receive extended dual antiplatelet therapy (DAPT), particularly to protect against stent thrombosis (ST). The selection of an optimal DAPT strategy in this setting remains challenging given the intrinsic ischemic and bleeding risk. Previous observations have not clearly established the impact of non-standard DAPT duration regimens on ischemic events in complex PCI patients. This study aims to assess the effect of non-standard DAPT duration on ischemic events in this setting.</p> Methods and results <p>We searched for randomized trials comparing DAPT duration regimens in patients undergoing complex PCI. The primary outcome was definite/probable ST. Other outcomes were myocardial infarction (MI), all-cause death, and major bleeding. Seven trials with a total of 46,696 patients undergoing either complex (<i>n</i> = 13,469) or non-complex (<i>n</i> = 33,227) PCI were included in the analysis. In complex PCI patients, the risk of definite/probable ST was not significantly different between the non-standard DAPT and standard DAPT groups (incidence rate ratio (IRR) 1.08; 95% confidence intervals (CI) 0.63–1.82). Consistently, the risk of MI (IRR 0.87; 95% CI 0.70–1.09), all-cause death (IRR 0.85; 95% CI 0.51–1.39), and major bleeding (IRR 0.63; 95% CI 0.33–1.19) did not differ significantly between DAPT strategies. Treatment effect for definite/probable ST by DAPT duration strategy was independent of PCI complexity.</p> Conclusions <p>In patients undergoing complex PCI, we found no significant differences in stent thrombosis, myocardial infarction, all-cause death, and major bleeding between DAPT duration strategies.</p> PROSPERO registration number <p>CRD42024617534.</p> Graphical abstract <p>Dual antiplatelet therapy duration and thrombotic risk in patients undergoing complex PCI. Association between DAPT duration and the incidence of definite or probable ST and MI in patients undergoing complex PCI. Complex PCI was defined according to the trial definitions, no restrictions were applied. Standard DAPT was defined as the conventional, non-tailored regimen with a fixed duration of 6 or 12&#xa0;months. Non-standard DAPT was defined as regimens with modified duration, including extended, abbreviated, or de-escalated approaches. No significant difference in definite/probable ST and MI between complex PCI patients treated with non-standard DAPT and those treated with standard DAPT were detected. <i>DAPT</i>&#xa0;dual antiplatelet therapy, <i>PCI</i>&#xa0;percutaneous coronary intervention, <i>RCT</i>&#xa0;randomized controlled trial, <i>ST</i>&#xa0;stent thrombosis.</p> <p></p>

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Duration of dual antiplatelet therapy and risk of stent thrombosis in patients undergoing complex PCI: a meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月28日

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  • Fiorenzo Simonetti,
  • Claudia Carassia,
  • Hector Alfonso Alvarez Covarrubias,
  • Michael Joner,
  • Thorsten Kessler,
  • Tobias Rheude,
  • Hendrik Sager,
  • Felix Voll,
  • Moritz von Scheidt,
  • Erion Xhepa,
  • Adnan Kastrati,
  • Salvatore Cassese

摘要

Background

Patients undergoing complex percutaneous coronary intervention (PCI) have a higher risk of ischemic events and often receive extended dual antiplatelet therapy (DAPT), particularly to protect against stent thrombosis (ST). The selection of an optimal DAPT strategy in this setting remains challenging given the intrinsic ischemic and bleeding risk. Previous observations have not clearly established the impact of non-standard DAPT duration regimens on ischemic events in complex PCI patients. This study aims to assess the effect of non-standard DAPT duration on ischemic events in this setting.

Methods and results

We searched for randomized trials comparing DAPT duration regimens in patients undergoing complex PCI. The primary outcome was definite/probable ST. Other outcomes were myocardial infarction (MI), all-cause death, and major bleeding. Seven trials with a total of 46,696 patients undergoing either complex (n = 13,469) or non-complex (n = 33,227) PCI were included in the analysis. In complex PCI patients, the risk of definite/probable ST was not significantly different between the non-standard DAPT and standard DAPT groups (incidence rate ratio (IRR) 1.08; 95% confidence intervals (CI) 0.63–1.82). Consistently, the risk of MI (IRR 0.87; 95% CI 0.70–1.09), all-cause death (IRR 0.85; 95% CI 0.51–1.39), and major bleeding (IRR 0.63; 95% CI 0.33–1.19) did not differ significantly between DAPT strategies. Treatment effect for definite/probable ST by DAPT duration strategy was independent of PCI complexity.

Conclusions

In patients undergoing complex PCI, we found no significant differences in stent thrombosis, myocardial infarction, all-cause death, and major bleeding between DAPT duration strategies.

PROSPERO registration number

CRD42024617534.

Graphical abstract

Dual antiplatelet therapy duration and thrombotic risk in patients undergoing complex PCI. Association between DAPT duration and the incidence of definite or probable ST and MI in patients undergoing complex PCI. Complex PCI was defined according to the trial definitions, no restrictions were applied. Standard DAPT was defined as the conventional, non-tailored regimen with a fixed duration of 6 or 12 months. Non-standard DAPT was defined as regimens with modified duration, including extended, abbreviated, or de-escalated approaches. No significant difference in definite/probable ST and MI between complex PCI patients treated with non-standard DAPT and those treated with standard DAPT were detected. DAPT dual antiplatelet therapy, PCI percutaneous coronary intervention, RCT randomized controlled trial, ST stent thrombosis.