Extended Dual Antiplatelet Therapy for Multivessel Coronary Artery Disease

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Multivessel coronary artery disease (CAD) management often involves 12 months of dual antiplatelet therapy (DAPT) post-stenting to prevent ischemic events.
• The optimal duration of DAPT in event-free patients with multivessel CAD remains uncertain.

Purpose of the Study:

• To evaluate the efficacy and safety of extending DAPT beyond 12 months in patients with multivessel CAD.

Main Methods:

• An open-label, randomized trial involving 8250 patients across 97 centers in China.
• Patients received either an additional 12 months of DAPT (clopidogrel plus aspirin) or aspirin monotherapy.
• Primary endpoints included major adverse cardiovascular events and clinically relevant or major bleeding (BARC type ≥2).

Main Results:

• Extended DAPT showed a significantly lower incidence of primary efficacy endpoint events (5.8% vs. 6.8%; HR, 0.82; P=0.03).
• No significant increase in clinically relevant or major bleeding was observed between the extended DAPT group and the aspirin monotherapy group (1.4% vs. 1.5%; HR, 0.89; P=0.54).

Conclusions:

• Extending DAPT for an additional 12 months in stable patients with multivessel CAD after drug-eluting stent implantation reduces ischemic events.
• This extended DAPT strategy is safe, showing no increased risk of bleeding compared to aspirin monotherapy.