January 29, 2026
2 min read
Key takeaways:
- At 3 years, 3-month DAPT was noninferior to 12-month DAPT after PCI with third-generation stents.
- Target lesion failure risk was similar, but more bleeding events occurred in the extended DAPT group.
Abbreviated dual antiplatelet therapy after percutaneous coronary intervention using third-generation stents remained noninferior vs. 12-month DAPT for non-ST-segment elevation myocardial infarction out to 3 years, researchers reported.
Additionally, patients who were event-free at 1 year but remained on DAPT experienced no difference in ischemic outcomes but higher rates of major bleeding events vs. those who switched to single antiplatelet therapy within a year, according to the long-term results of the HOST-IDEA trial published in eClinicalMedicine.
At 3 years, 3-month DAPT was noninferior to 12-month DAPT after PCI with third-generation stents. Image: Adobe Stock
“This study extends the clinical follow-up of the HOST-IDEA trial to 3 years and shows comparable long-term outcomes between 3-to-6-month and 12-month DAPT after third-generation drug-eluting stent implantation,” Jung-Kyu Han, MD, of the Cardiovascular Center at the Seoul National University Hospital in Seoul, South Korea, and colleagues wrote. “Continuation of DAPT beyond 1 year was associated with an increased risk of major bleeding without a clear reduction in ischemic events. These findings support the long-term safety and efficacy of abbreviated DAPT in the contemporary drug-eluting stent era.”
The HOST-IDEA trial
HOST-IDEA was a randomized, open-label, multicenter trial that compared antiplatelet monotherapy after 3-month DAPT and 12-month DAPT in an all-comers cohort of 2,013 patients with de novo stenotic lesions (mean age, 66 years; 74% men) without STEMI who underwent PCI with third-generation drug-eluting stents (Orsiro, Biotronik; Coroflex ISAR, B. Braun).
The primary endpoint was net adverse clinical events, a composite of cardiac death, target vessel MI, clinically driven target lesion revascularization, stent thrombosis and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 12 months after PCI.
As Healio previously reported, 3-month DAPT was noninferior to 12-month DAPT for the composite outcome of net adverse clinical events, with similarly elevated bleeding events between the two groups.
In the present study, researchers evaluated the long-term outcomes of abbreviated DAPT out to 3 years after PCI. The primary outcome was prespecified as mandatory clinical follow-up and remained the same as the initial analysis.
Long-term outcomes with shortened DAPT
To evaluate outcomes related to more than 1 year of DAPT, patients who were event-free at 1 year were stratified into more than 1 year and 1 year or less DAPT groups and propensity matched.
At 3 years, clinical follow-up was completed in approximately 95% of the overall cohort, with a median follow-up duration of 1,095 days.
Researchers reported the primary outcome occurred in 7.7% of the abbreviated DAPT group vs. 8.2% of patients assigned to the 12-month DAPT group (HR = 0.94; 95% CI, 0.69-1.29; P = .71) and risk of target lesion failure (HR = 0.92; 95% CI, 0.62-1.36; P = .66) and major bleeding were similar (HR = 0.96; 95% CI, 0.59-1.56; P = .88).
Among patients who remained event-free and stayed on DAPT after 1 year, there was a trend for increased risk for target lesion failure vs. those who switched to single antiplatelet therapy within 1 year (HR = 2.56; 95% CI, 0.99-6.6; P = .05) and a significantly higher risk for bleeding events (HR = 4.44; 95% CI, 1.26-15.57; P = .02).
“These findings support the long-term safety and efficacy of abbreviated DAPT in the contemporary DES era,” the researchers wrote. “Further research is needed to determine how much shorter DAPT can be safely administered and to identify the optimal antiplatelet agents both during DAPT and for subsequent single antiplatelet therapy.”
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