Recurrent Events Analysis of MASTER DAPT: Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in HBR Patients

Bongiovanni, D; Landi, A; Frigoli, E; Heg, D; Chalkou, K; Bartunek, J; Delorme, L; Dewilde, W; Hildick-Smith, D; Leibundgut, G; Leonardi, S; Lesiak, M; Kala, P; Kedev, S; Roffi, M; Stankovic, G; Tonino, PAL; Velchev, V; Vranckx, P; Windecker, S; Smits, PC; Valgimigli, M; MASTER DAPT Investigators

doi:10.1016/j.jacc.2025.05.010

Coronary disease & ACS

Recurrent Events Analysis of MASTER Dual Antiplatelet Therapy (DAPT): Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in High Bleeding Risk (HBR) Patients

J Am Coll CardiolPublished 22 May 2025Secondary analysis of the MASTER DAPT randomised trial

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Authors' conclusion

A 1-month DAPT duration was associated with similar total NACEs and MACCEs and reduced total bleeding risk compared with prolonged DAPT.

Study context

Population: HBR patients after percutaneous coronary intervention (PCI)
Participants: 4,579 patients

Comparison: Abbreviated vs prolonged DAPT
Abbreviated DAPTn = 2,295
Prolonged DAPTn = 2,284reference
Primary endpoint: Total (recurrent) events of the coprimary outcomes: NACE (all-cause death, myocardial infarction (MI), stroke, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding); MACCE (all-cause death, MI, stroke); MCB (BARC 2, 3 or 5 bleeding)
Follow-up: 335 days

Methodological detailsrecurrent events analysis

Recurrent events analysis

Primary result

As reported in the abstract

Abbreviated DAPT

NACE: 214 NACEs in 172 patients
MACCE: 156 MACCEs in 138 patients
MCB: 180 MCBs in 148 patients

Prolonged DAPT

NACE: 227 NACEs in 182 patients
MACCE: 160 MACCEs in 138 patients
MCB: 240 MCBs in 211 patients

NACE

Abbreviated DAPT214 NACEs in 172 patients

Prolonged DAPT227 NACEs in 182 patients

MACCE

Abbreviated DAPT156 MACCEs in 138 patients

Prolonged DAPT160 MACCEs in 138 patients

MCB

Abbreviated DAPT180 MCBs in 148 patients

Prolonged DAPT240 MCBs in 211 patients

Abbreviated DAPT vs Prolonged DAPTHazard ratio (95% CI)P value

NACE

0.95(0.78–1.16)

P = 0.64

MACCE

0.96(0.76–1.20)

P = 0.69

MCB

0.78(0.64–0.94)

P = 0.011

Further findings

Outcome	← Lower risk with abbreviated DAPT ←→ Higher risk with abbreviated DAPT →	HR (95% CI)	P value
Total cerebrovascular accidents and total strokesAbbreviated DAPTvs Prolonged DAPTCerebrovascular accidents: 34 events in 32 patients	0.20.5125	0.51 (0.28–0.91)	P = 0.023
Total cerebrovascular accidents and total strokesAbbreviated DAPTvs Prolonged DAPTStrokes: 25 events in 24 patients	0.20.5125	0.49 (0.25–0.98)	P = 0.04
	0.20.5125Hazard ratio (log scale)

Sequence of events

Major adverse cardiac and cerebral events (MACCEs) occurring after a bleeding event: 1 in every 5
Bleeding events occurring after a MACCE: 1 in every 25

Original publication

Recurrent Events Analysis of MASTER DAPT: Total Ischemic and Bleeding Events After Abbreviated vs Prolonged DAPT in HBR Patients. J Am Coll Cardiol. Published 22 May 2025. doi:10.1016/j.jacc.2025.05.010

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