Presented by Dr. Marco Valgimigli, the MASTER DAPT trial assessed whether 1 month of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), with a drug-eluting coronary stent maintained, the same benefit in relation to cardiovascular events as longer duration DAPT (6-12 months); whilst reducing adverse bleeding events.
Currently, guidelines advise reducing the duration of DAPT to 6 months or less in patients with high risk of bleeding, although the current recommendation is level C, based on expert consensus.
4,579 patients were randomised in a 1:1 ratio to either discontinuation of DAPT after a median of 34 days (abbreviated-therapy group), or continuation of DAPT for a total of at least 6 months following stent implantation (standard-therapy group). The three ranked primary outcomes were net adverse clinical events (all-cause mortality, myocardial infarction (MI), stroke), major adverse cardiac or cerebral events (all-cause mortality, MI, stroke), and major or clinically relevant nonmajor bleeding. Cumulative incidences were assessed at 335 days.
Among the 4,547 patients who completed follow-up at 335 days, net adverse clinical events occurred in 165 patients (7.5%) in the abbreviated-therapy group and in 172 (7.7%) in the standard-therapy group (difference, −0.23 percentage points; 95% confidence interval [CI], −1.80 to 1.33; P<0.001 for noninferiority). A total of 133 patients (6.1%) in the abbreviated-therapy group and 132 patients (5.9%) in the standard-therapy group had a major adverse cardiac or cerebral event (difference, 0.11 percentage points; 95% CI, −1.29 to 1.51; P=0.001 for noninferiority). Major or clinically relevant nonmajor bleeding occurred in 148 patients (6.5%) in the abbreviated-therapy group and in 211 (9.4%) in the standard-therapy group (difference, −2.82 percentage points; 95% CI, −4.40 to −1.24; P<0.001 for superiority).
Overall, in patients with high bleeding risk, 1 month of DAPT following PCI in was found to preserve ischaemic benefit whilst reducing bleeding risk.
Source: Valgimigli M, et al. MASTER DAPT. Presented at: European Society of Cardiology Congress; Aug. 27-30, 2021 (virtual meeting).
Valgimigli M, Frigoli E, Heg D, et al., on behalf of the MASTER DAPT Investigators. Dual Antiplatelet Therapy After PCI in Patients at High Bleeding Risk. N Engl J Med 2021;Aug 28:[Epub ahead of print].
Figure 1 (Top): Taken from the ESC Congress 2021. Visual abstract of the MASTER DAPT trial.