Abstract 4147145: Short Dual Antiplatelet Therapy Followed by P2Y12 Inhibitor Monotherapy versus 1-Year Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Introduction: Current guidelines recommend dual antiplatelet therapy (DAPT) for 6 months for stable ischemic heart disease and 12 months for acute coronary syndrome following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. However, long-term DAPT is associated with increased bleeding risk. Objective: To compare short DAPT (≤3 months) followed by P2Y12 inhibitor (P2Y12i) monotherapy until 12 months vs. standard DAPT for 12 months in patients undergoing PCI with DES. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing short DAPT followed by P2Y12i monotherapy vs. 12-month DAPT following PCI. The co-primary outcomes were composite major adverse cardiovascular/cerebrovascular events (MACCE) and net adverse clinical events (NACE; MACCE + bleeding events) at 12 months post-PCI. Secondary outcomes were major and any bleeding, myocardial infarction (MI), stroke, stent thrombosis, all-cause and cardiovascular mortality, and target vessel revascularization (TVR) at 12 months post-PCI. Results: The systematic review identified 8 randomized controlled trials including 39,782 patients (short DAPT n=19,877, 49.96%). MACCE (RR 0.88; 95%CI 0.78-0.98; p=0.023; I 2 =0%) and NACE (RR 0.75; 95%CI 0.65-0.86; p<0.001; I 2 =56%) at 12 months were significantly lower with short DAPT than 12-month DAPT. Major (RR 0.52; 95%CI 0.37-0.72; p<0.001; I 2 =63%) and any bleeding (RR 0.55; 95%CI 0.42-0.73; p<0.001; I 2 =80%) were also significantly lower with short DAPT. MI, stroke, stent thrombosis, all-cause and cardiovascular mortality, and TVR at 12 months did not differ significantly between short and 12-month DAPT. Conclusion: Short DAPT for ≤3 months followed by P2Y12i monotherapy after PCI with DES was associated with decreased MACCE, NACE, and bleeding without differences in other outcomes. Short DAPT should be considered for high-bleeding risk patients.