Three versus 12-month dual antiplatelet therapy duration in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials

Catheter Cardiovasc Interv. 2022 Dec;100(7):1151-1158. doi: 10.1002/ccd.30467. Epub 2022 Nov 3.


Introduction: The American Heart Association/American College of Cardiology guidelines on dual antiplatelet therapy (DAPT) recommend at least 12 months of a P2Y12 inhibitor and low dose aspirin in patients with an acute coronary syndrome (ACS) treated with a stent. Since that recommendation, several randomized controlled trials (RCTs) have studied an abbreviated duration of DAPT in ACS. Therefore, we sought to perform a meta-analysis of RCTs comparing 3- versus 12-month DAPT in patients presenting with ACS undergoing percutaneous coronary intervention (PCI).

Methods: PubMed, Embase, and Cochrane Central databases were searched until July 31, 2022, for RCTs comparing 3- versus 12-month DAPT in patients with ACS undergoing PCI. Outcomes assessed were major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), stent thrombosis (ST) and bleeding. A random-effects model was used to calculate pooled relative risk (RR) and 95% confidence intervals (CI).

Results: We included 5 trials comprising 16,781 patients with an ACS that underwent PCI. There was no significant difference in MACE (RR: 0.92; 95% CI: 0.76-1.11), cardiovascular mortality (RR: 1.26; 95% CI: 0.38-4.17), or all-cause mortality (RR: 0.92; 95% CI: 0.48-1.77) between the 2 groups. In addition, there was no difference in rates of MI (RR: 0.98; 95% CI: 0.74-1.30), or ST (RR: 1.30; 95% CI: 0.55-3.05) between 3- and 12-month DAPT. However, compared with 12-month DAPT, 3-month DAPT significantly reduced risk of major bleeding (RR: 0.53; 95% CI: 0.43-0.64).

Conclusions: In patients with ACS undergoing PCI, 3-month DAPT reduced risk of bleeding without evidence of harm.

Keywords: DAPT; acute coronary syndrome; bleeding; outcomes; percutaneous intervention.

Publication types

  • Meta-Analysis

MeSH terms

  • Acute Coronary Syndrome* / drug therapy
  • Acute Coronary Syndrome* / surgery
  • Drug Therapy, Combination
  • Duration of Therapy
  • Hemorrhage / chemically induced
  • Humans
  • Myocardial Infarction / etiology
  • Percutaneous Coronary Intervention* / adverse effects
  • Platelet Aggregation Inhibitors* / adverse effects
  • Randomized Controlled Trials as Topic
  • Thrombosis / etiology
  • Treatment Outcome


  • Platelet Aggregation Inhibitors