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One- versus three-month DAPT after everolimus-eluting stent implantation in diabetic patients at high bleeding risk:

Angelo Oliva1,2, Dominick J Angiolillo3, Marco Valgimigli4,5

  • 1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|June 16, 2025
PubMed

Insights

For patients with diabetes and high bleeding risk undergoing PCI, 1-month dual antiplatelet therapy (DAPT) is as safe as 3-month DAPT regarding heart attack risk and reduces bleeding events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetes Mellitus Management

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) is uncertain.
  • Diabetic patients undergoing PCI often have higher risks of adverse cardiovascular events.

Purpose of the Study:

  • To compare the efficacy and safety of early DAPT discontinuation (1-month vs. 3-month) in diabetic versus non-diabetic patients.
  • To evaluate ischemic and bleeding outcomes in the XIENCE Short DAPT program.

Main Methods:

  • Propensity score stratification was used to compare 1-month versus 3-month DAPT durations.
  • The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 1 year.
  • Key secondary endpoint was Bleeding Academic Research Consortium (BARC) Type 2 to 5 bleeding.

Main Results:

  • Diabetic patients (38.8%) had a higher incidence of death or MI compared to non-diabetic patients (10.1% vs. 6.6%).
  • One-month DAPT was not associated with a statistically significant difference in death or MI for DM patients (adjHR 0.70) or non-DM patients (adjHR 1.26), though heterogeneity by DM status was observed (p=0.015).
  • Bleeding events (BARC 2-5) were numerically lower with 1-month DAPT in both DM (adjHR 0.67) and non-DM patients (adjHR 0.78).

Conclusions:

  • In HBR patients with DM undergoing PCI, 1-month DAPT is not associated with increased risk of fatal or non-fatal MI compared to 3-month DAPT.
  • Shorter DAPT duration (1-month) reduced bleeding events in both diabetic and non-diabetic patients.
  • Findings apply to stable patients with low procedural complexity and may not generalize to higher-risk cases.
Abstract

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