In patients with multivessel coronary artery disease who remain stable 12 months after drug-eluting stent (DES) stenting, there is uncertainty as to prolonging dual antiplatelet therapy (DAPT) with aspirin (ASA) and clopidogrel vs de-escalating to ASA monotherapy. The potential ischemic benefits of extended DAPT should be balanced against bleeding risk and long-term adherence challenges.
The DAPT-MVD trial was a randomized, multicenter, open-label study conducted across 97 centers in China, enrolling 8,250 patients. It compared extended DAPT (ASA + clopidogrel for 12 months) vs ASA monotherapy starting 12 months post-DES stenting.
The primary endpoint at 36 months was major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal MI, or nonfatal stroke.
Results showed 5.8% MACE incidence for extended DAPT patients without significant increase in major bleeding vs 6.8% for ASA only patients (HR 0.82; 95% CI 0.69–0.98; p=0.03).
Conclusions
Among multivessel patients 12 months after DES stenting, extending dual antiplatelet therapy for one additional year was associated with a modest but statistically significant reduction in MACE, without a relevant increase in bleeding risk.
Presented by Jinwei Tian, Late-Breaking Science Session, AHA 2025, New Orleans, USA.
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