Duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for bifurcation lesions: a systematic review and meta-analysis

BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions remains uncertain. This meta-analysis focused on comparing ischemic and bleeding outcomes between short-term (≤6 months) and long-term (>6 months) DAPT in this high-risk subgroup. METHODS: We included six studies comprising 12 066 patients with bifurcation lesions treated with drug-eluting stents and either short- or long-term DAPT. Pooled relative risk (RR) and 95% confidence intervals (CI) were calculated for major adverse cardiovascular events (MACE), all-cause and cardiac mortality, myocardial infarction, stent thrombosis, stroke, bleeding, and target lesion revascularization. RESULTS: Short-term DAPT was associated with significantly higher risks of MACE (RR 1.79; 95% CI 1.05-3.07), all-cause mortality (RR: 2.78; 95% CI: 1.49-5.19), cardiac death (RR 2.29; 95% CI 1.34-3.91), and stent thrombosis (RR: 4.90; 95% CI: 2.78-8.66). Although the risks of myocardial infarction (RR: 1.75; 95% CI: 0.69-4.47), stroke (RR: 1.07; 95% CI: 0.61-1.67), bleeding (RR: 1.49; 95% CI: 0.24-9.48), and target lesion revascularization (RR: 1.35; 95% CI: 0.85-2.12) did not reach statistical significance, the effect estimates consistently favored long-term DAPT. CONCLUSION: In patients undergoing percutaneous coronary intervention for bifurcation lesions, short-term DAPT was associated with significantly worse ischemic outcomes, including increased rates of MACE, death, and stent thrombosis. These findings support the use of extended DAPT duration as the preferred strategy in this anatomical subgroup, with treatment tailored according to individual bleeding risk.