Personalized or Standard Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Background: Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain. Objectives: The authors performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3, 6, or 24 months with a standard duration of DAPT for 12 months after PCI. Methods: We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary endpoint was a net adverse clinical event (NACE) at 24 months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium criteria. Results: At 24 months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points; 95% CI: −6.99 to −0.99; P = 0.040). This difference was mainly related to decreased rates of myocardial infarction (difference, −2.29 percentage points; 95% CI: −4.43 to −0.14) and urgent target vessel revascularization (difference, −1.30 percentage points; 95% CI: −2.55 to −0.05). Bleeding occurred at similar rates between the 2 groups (difference, −0.41 percentage points; 95% CI: −2.92 to 2.10). Conclusions: In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of NACE than standard care consisting of 12 months of DAPT. (Personalized Vs. Standard Duration of Dual Antiplatelet Therapy and New-generation Polymer-Free vs- Biodegradable-Polymer DES [PARTHENOPE]; NCT04135989)