Abstract 4371704: Duration of Potent P2Y12 Inhibitor-Based DAPT after Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Frequentist Pairwise and Network Meta-Analysis

Abstract

Introduction: Dual antiplatelet therapy (DAPT) for 12 months is recommended as the standard strategy following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Short DAPT (1-3 months) followed by ticagrelor monotherapy is recommended for patients with high bleeding risk. Objective: We performed a frequentist pairwise and network meta-analysis comparing the durations of DAPT using potent P2Y12 inhibitors (P2Y12i) (ticagrelor, prasugrel) in patients undergoing PCI for ACS. Methods: PubMed, Scopus, and Cochrane CENTRAL databases were searched from inception through 5/2025 for randomized controlled trials (RCTs) comparing different potent P2Y12i-based DAPT durations. Outcomes of interest were major adverse cardiovascular events (MACE), net adverse clinical events (NACE; MACE + bleeding events), major bleeding, any bleeding, all-cause death, cardiac death, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization. Frequentist random-effects pairwise and network meta-analysis was performed to calculate risk ratios (RRs) with 95% confidence intervals (CIs). DAPT strategies were ranked using P-scores. Results: Seven RCTs with 23,054 patients comparing 3 strategies (1-month DAPT: 31.2%; 3-month DAPT: 18.6%; 12-month DAPT: 50.2%) were included. Short DAPT reduced the risk of NACE (RR 0.70; 95%CI 0.59-0.84; p<0.001; I 2 =51.2%), major bleeding (RR 0.42; 95%CI 0.33-0.54; p<0.001; I 2 =4%), and any bleeding (RR 0.51; 95%CI 0.43-0.61; p<0.001; I 2 =33.9%) compared with 12-month DAPT (Image 1). In the network comparison, 1-month and 3-month DAPT followed by potent P2Y12i monotherapy exhibited comparable P-scores and were identified as best to reduce NACE. 1-month DAPT was ranked to be the best strategy in reducing major and any bleeding. Conclusion: In patients with ACS undergoing PCI, potent P2Y12i monotherapy after short DAPT for ≤3 months reduced NACE, major bleeding, and any bleeding without increasing other adverse outcomes. A 1-month DAPT duration followed by P2Y12i monotherapy showed the most favorable bleeding profile, while both 1-month and 3-month DAPT durations were effective in reducing NACE. Short-term DAPT is a recommended approach for patients at high bleeding risk.