Extended Versus Short Dual Antiplatelet Therapy Duration After Percutaneous Coronary Intervention for Chronic Total Occlusion

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with substantial ischemic risk, yet the optimal duration of dual antiplatelet therapy (DAPT) after successful CTO-PCI remains uncertain. We conducted a systematic review and meta-analysis comparing extended DAPT (>12 months) with short-term DAPT (≤12 months) following CTO-PCI. Four electronic biomedical databases were searched from inception to September 2026. Comparative studies evaluating adult patients undergoing successful CTO-PCI with drug-eluting stent implantation were eligible. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Three retrospective cohort studies including 3362 patients were identified, with 1761 receiving extended DAPT and 1601 receiving short-term DAPT. Extended DAPT was associated with a significantly lower risk of major adverse cardiovascular events compared with short-term DAPT (RR 0.68; 95% CI 0.55-0.84; P = 0.0004). There was no significant difference in all-cause death (RR 0.25; 95% CI 0.04-1.41; P = 0.116), myocardial infarction, stroke, cardiovascular death, major bleeding, or revascularization outcomes. However, extended DAPT was associated with a significantly higher risk of total bleeding (RR 2.34; 95% CI 1.31-4.20; P = 0.0043). Among patients undergoing successful CTO-PCI, extended DAPT was associated with lower major adverse cardiovascular events but increased total bleeding compared with DAPT ≤12 months.