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Duration of dual antiplatelet therapy and risk of stent thrombosis in patients undergoing complex PCI: a

Fiorenzo Simonetti1,2, Claudia Carassia1, Hector Alfonso Alvarez Covarrubias1

  • 1Klinik Für Herz- und Kreislauferkrankungen, TUM Klinikum Deutsches Herzzentrum, Technische Universität München, Munich, 80636, Germany.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|April 28, 2026
PubMed

Insights

For complex percutaneous coronary intervention (PCI), non-standard dual antiplatelet therapy (DAPT) durations did not significantly alter risks of stent thrombosis, myocardial infarction, death, or major bleeding compared to standard DAPT. These findings apply regardless of PCI complexity.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Patients with complex percutaneous coronary intervention (PCI) face elevated ischemic event risks.
  • Extended dual antiplatelet therapy (DAPT) is common for preventing stent thrombosis (ST) but balancing ischemic and bleeding risks is challenging.
  • The impact of non-standard DAPT durations on outcomes in complex PCI is not well-established.

Purpose of the Study:

  • To evaluate the effect of non-standard DAPT duration regimens on ischemic events in patients undergoing complex PCI.
  • To compare the risks of stent thrombosis, myocardial infarction, all-cause death, and major bleeding between standard and non-standard DAPT durations in complex PCI.

Main Methods:

  • A systematic search for randomized trials comparing DAPT duration strategies in complex PCI patients was conducted.
  • Seven trials involving 46,696 patients (13,469 complex PCI) were included.
  • Primary outcome was definite/probable stent thrombosis; secondary outcomes included myocardial infarction, all-cause death, and major bleeding.

Main Results:

  • No significant difference in definite/probable ST risk was observed between non-standard and standard DAPT groups in complex PCI patients (IRR 1.08; 95% CI 0.63-1.82).
  • Risks for myocardial infarction (IRR 0.87), all-cause death (IRR 0.85), and major bleeding (IRR 0.63) also showed no significant differences.
  • The treatment effect on ST was independent of PCI complexity.

Conclusions:

  • In complex PCI patients, varying DAPT durations did not lead to significant differences in stent thrombosis, myocardial infarction, death, or major bleeding.
  • Current evidence suggests DAPT duration strategies may not critically impact key ischemic and bleeding outcomes in complex PCI settings.
Abstract

Keywords:
Complex percutaneous coronary interventionCoronary artery diseaseDual antiplatelet therapyStent thrombosis

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