Physicians' Academy for Cardiovascular Education

Comparison of one month DAPT with standard DAPT in high bleeding risk patients after PCI

News - Aug. 28, 2021

Management of high bleeding risk patients post bioresorbable polymer coated STEnt implantation with an abbreviated versus prolonged DAPT regimen (MASTER DAPT)

Presented at the ESC congress 2021 by: Macro Valgimigli, MD, PhD Lugano, Switzerland

Introduction and methods

The MASTER DAPT trial was designed to evaluate whether the effect of an abbreviated dual antiplatelet therapy (DAPT) regimen compared with a standard DAPT regimen was preserved on net and major clinical events in a high bleeding risk (HBR) population who underwent percutaneous coronary intervention (PCI) with biodegradable polymer Ultimaster stent. In addition, the effect on bleeding risk was assessed.

4579 HBR patients who underwent PCI who were free from ischemic events were randomized at 1 months to immediately stop DAPT or continue DAPT for at least 2 additional months (median duration of additional DAPT was 193 days after PCI). Outcomes were assessed at 1 year. There were 3 co-primary endpoints: net adverse clinical events, which were a composite of death, MI, stroke and major bleeding defined as BARC 3 (first end point); major adverse cardiac or cerebral events (MACE), the composite of death, MI or stroke (second); major or clinically relevant nonmajor bleeding (third).

Main results

Conclusion

One-month DAPT was noninferior to treatment continuation of DAPT for at least 2 extra months for the outcome of net and major adverse clinical events and reduced major or clinically relevant nonmajor bleeding in HBR patients after PCI with Ultimaster stent implantation.

This results indicate that coronary stents have become safer and the last generation DES such as the Ultimaster stent requires only limited duration of DAPT therapy.

The results were simultaneously presented in N Engl J Med.

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