One-Month DAPT Enough for Complex PCI if Bleeding Risk High
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In patients at high bleeding risk who had undergone percutaneous coronary intervention (PCI), 1 month of dual antiplatelet therapy (DAPT) was associated with a similar rate of major adverse cardiac or cerebral events but a lower bleeding risk than a longer duration of DAPT, even in patients undergoing complex PCI.

Of the 4579 patients in the overall MASTER DAPT trial, 1196 (26%) underwent a complex PCI. The baseline angiographic and procedural characteristics, stratified by PCI complexity, were well balanced between the two antiplatelet regimens. Although the majority (74%) of the patients classified a having complex PCI had just one criterion to qualify as complex, there was a significant minority with two or more criteria, showing that this was truly a complex PCI population. The trial had three coprimary endpoints to be tested in a hierarchical order:
Net adverse clinical events: the composite of all-cause death, myocardial infarction (MI), stroke, and major bleeding defined as BARC type 3 or 5;
Major adverse cardiac and cerebral events: the composite of all-cause death, MI, and stroke; and
Major or clinically relevant nonmajor bleeding: the composite of BARC type 2, 3 and 5 bleeding.

Results showed that the outcomes of net adverse clinical outcomes and major adverse cardiovascular events were similar for both antiplatelet treatment groups, and there was no difference between the results in patients receiving complex PCI and those receiving noncomplex PCI. For net adverse clinical outcomes, the hazard ratio was 1.03 (95% CI, 0.69 - 1.52) for the complex PCI population and 0.90 (95% CI, 0.71 - 1.15) for the noncomplex PCI population, with an interaction P value of .60. For major adverse cardiac and cerebral events, the hazard ratio was 1.24 (95% CI, 0.79 - 1.92) for the complex PCI population and 0.91 (95% CI, 0.69 - 1.21) for the noncomplex PCI population, with an interaction P value of .26.