Abbreviated or Standard Antiplatelet Therapy in HBR Patients: Final 15-Month Results of the MASTER-DAPT Trial

MASTER DAPT Investigators, Antonio Landi, Dik Heg, Enrico Frigoli, Pascal Vranckx, Stephan Windecker, Patrick Siegrist, Guillaume Cayla, Adrian Włodarczak, Stephane Cook, Iván Gómez-Blázquez, Yair Feld, Park Seung-Jung, Martin Mates, Chaim Lotan, Sengottuvelu Gunasekaran, Mamoru Nanasato, Rajiv Das, Henning Kelbæk, Emmanuel TeigerJavier Escaned, Yuki Ishibashi, Gilles Montalescot, Hitoshi Matsuo, Dragan Debeljacki, Pieter C Smits, Marco Valgimigli

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BACKGROUND: Clinical outcomes and treatment selection after completing the randomized phase of modern trials, investigating antiplatelet therapy (APT) after percutaneous coronary intervention (PCI), are unknown.

OBJECTIVES: The authors sought to investigate cumulative 15-month and 12-to-15-month outcomes after PCI during routine care in the MASTER DAPT trial.

METHODS: The MASTER DAPT trial randomized 4,579 high bleeding risk patients to abbreviated (n = 2,295) or standard (n = 2,284) APT regimens. Coprimary outcomes were net adverse clinical outcomes (NACE) (all-cause death, myocardial infarction, stroke, and BARC 3 or 5 bleeding); major adverse cardiac and cerebral events (MACCE) (all-cause death, myocardial infarction, and stroke); and BARC type 2, 3, or 5 bleeding.

RESULTS: At 15 months, prior allocation to a standard APT regimen was associated with greater use of intensified APT; NACE and MACCE did not differ between abbreviated vs standard APT (HR: 0.92 [95% CI: 0.76-1.12]; P = 0.399 and HR: 0.94 [95% CI: 0.76-1.17]; P = 0.579; respectively), as during the routine care period (HR: 0.81 [95% CI: 0.50-1.30]; P = 0.387 and HR: 0.74 [95% CI: 0.43-1.26]; P = 0.268; respectively). BARC 2, 3, or 5 was lower with abbreviated APT at 15 months (HR: 0.68 [95% CI: 0.56-0.83]; P = 0.0001) and did not differ during the routine care period. The treatment effects during routine care were consistent with those observed within 12 months after PCI.

CONCLUSIONS: At 15 months, NACE and MACCE did not differ in the 2 study groups, whereas the risk of major or clinically relevant nonmajor bleeding remained lower with abbreviated compared with standard APT. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020).

Sider (fra-til)798-812
Antal sider15
TidsskriftJACC: Cardiovascular Interventions
Udgave nummer7
StatusUdgivet - 10 apr. 2023

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Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.


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