It was unknown how long patients with acute coronary syndrome and high bleeding risk (HBR) should continue antiplatelet therapy (APT) following coronary stenting. For a study, researchers sought to examine the effectiveness and safety of a condensed APT regimen following coronary stenting in patients with acute or recent myocardial infarction who were from the HBR group.

In the MASTER DAPT experiment, 4,579 patients at HBR were randomly assigned to either shortened (DAPT terminated and single APT continued for 11 months or 5 months in patients taking oral anticoagulants) or non-abbreviated (DAPT for a minimum of 3 months) APT methods after 1 month of dual APT (DAPT). The index procedure’s acute or recent myocardial infarction was used to stratify randomization. At 335 days following randomization, type 2, type 3, or type 5 Academic Research Consortium bleeding events, significant adverse cardiac and cerebral events, and net adverse clinical outcomes events (NACE) were coprimary outcomes.

In patients who had an acute or recent myocardial infarction (n = 1,780; HR: 0.83; 95% CI: 0.61-1.12 and HR: 0.86; 95% CI: 0.62-1.19, respectively) or who had not experienced an acute or recent myocardial infarction (n = 2,799; HR: 1.03; 95% CI: 0.77-1.38 and HR: 1.13; 95% CI: 0.80-1.59; Pinteraction = 0.31 and 0.25, respectively). Academic Research Consortium in Shock In patients with or without an acute or recent myocardial infarction, 2, 3, or 5 bleeding was substantially decreased by shortened APT (HR: 0.65; 95% CI: 0.46-0.91 and HR: 0.71; 95% CI: 0.54-0.92; Pinteraction = 0.72, respectively).

In comparison to a non-abbreviated DAPT method, a 1-month DAPT strategy in patients with HBR who reported an acute or recent myocardial infarction had equivalent NACE and MACCE rates and lowered bleedings.

 

Reference: jacc.org/doi/10.1016/j.jacc.2022.07.016