Dual Antiplatelet Therapy Duration After Multivessel Optimal Intravascular Ultrasound-Guided Percutaneous Coronary...

Current evidence on optimal dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) remains limited. While clinical guidelines suggest variable DAPT durations, real-world data are sparse. Prior research has shown mixed results regarding the benefits of prolonged DAPT in reducing adverse events. However, the role of DAPT duration in multivessel PCI specifically is unclear. No prior work had resolved how DAPT strategies affect outcomes in patients undergoing intravascular ultrasound (IVUS)-guided procedures. This gap motivated the OPTIVUS-Complex PCI study to evaluate DAPT discontinuation patterns and clinical outcomes. The study aimed to provide insights into the effectiveness of shorter versus longer DAPT in a real-world setting. No consensus exists on whether prolonged DAPT offers clear advantages in this patient group. The lack of robust evidence has left uncertainty about optimal post-PCI DAPT strategies.

The OPTIVUS-Complex PCI study sought to evaluate the real-world impact of DAPT duration after multivessel PCI. Specifically, the study aimed to compare outcomes between patients who discontinued DAPT and those who continued it. The primary goal was to assess whether prolonged DAPT reduces cardiovascular events in this patient population. The study also aimed to quantify the prevalence of DAPT discontinuation in clinical practice. No prior work had resolved whether DAPT duration significantly influences outcomes in multivessel PCI. The study focused on patients undergoing IVUS-guided procedures, a less commonly studied subgroup. The researchers proposed that DAPT discontinuation patterns could inform clinical decision-making. The study aimed to provide data to guide post-PCI DAPT duration in high-risk patients.

The OPTIVUS-Complex PCI study included 982 patients who underwent multivessel PCI with IVUS guidance. A 90-day landmark analysis was used to compare outcomes between shorter and longer DAPT groups. DAPT discontinuation was defined as stopping P2Y12 inhibitors or aspirin for at least 2 months. The study collected data on acute coronary syndrome and bleeding risk using the Bleeding Academic Research Consortium criteria. Clinical outcomes were tracked at 90 days and 1 year. The primary endpoints included a composite of death, myocardial infarction, stroke, or revascularization. Secondary endpoints focused on bleeding events. The study used statistical methods like log-rank tests and adjusted hazard ratios to compare groups.

At 90 days, 22.6% of patients discontinued DAPT, and 68.8% had discontinued by 1 year. The composite endpoint of death, myocardial infarction, stroke, or revascularization occurred in 5.9% of the off-DAPT group and 9.2% of the on-DAPT group. The adjusted hazard ratio was 0.59, with a 95% confidence interval of 0.32 to 1.08. No significant difference was observed between the groups (log-rank P=0.12). Bleeding events of BARC type 3 or 5 occurred in 1.4% of the off-DAPT group and 1.9% of the on-DAPT group (log-rank P=0.62). The 1-year incidence of cardiovascular events was not different between shorter and longer DAPT groups. These findings suggest prolonged DAPT does not reduce cardiovascular events in multivessel PCI patients. The low adoption of short DAPT duration indicates ongoing clinical uncertainty.

The study found no significant difference in cardiovascular events between shorter and longer DAPT groups after multivessel PCI. The authors propose that prolonged DAPT does not offer clear benefits in reducing adverse outcomes. The low rate of DAPT discontinuation suggests clinicians remain cautious about shortening DAPT duration. No apparent benefit of extended DAPT was observed in this real-world cohort. The findings suggest that current DAPT strategies may not be optimized for multivessel PCI patients. The results align with the lack of strong evidence supporting prolonged DAPT in this context. The authors suggest further research is needed to clarify optimal DAPT duration. These findings may inform future guidelines on post-PCI DAPT management.