Ultrashort vs Standard-Duration Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis
Authors' conclusion
In patients with ACS undergoing PCI, ultrashort DAPT reduced bleeding without increasing ischemic events overall, although a signal of increased MACCE was observed in STEMI but not in NSTE-ACS.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing PCI
- Participants
- 29,232 patients10 trials
- Comparison
- Ultrashort dual antiplatelet therapy (DAPT) vs standard-duration DAPT
- Outcome
- MACCE, major bleeding and net adverse clinical event (NACE)
Methodological detailsprespecified subgroup analyses
- Prespecified subgroup analyses
Pooled result
As reported in the abstract
Ultrashort DAPT vs Standard-duration DAPTHazard ratio (95% CI)P value
MACCE; I2 = 24%
1.06(0.93–1.20)
P = 0.38Major bleeding; I2 = 44%
0.47(0.35–0.64)
P < 0.00001NACE (net clinical benefit); I2 = 61%
0.83(0.72–0.97)
P = 0.02Further pooled results
Major adverse cardiac and cerebrovascular events (MACCE) by ACS type (subgroup)
- Higher MACCE risk with ultrashort DAPT in STEMI but not NSTE-ACS
Major bleeding by ethnicity (prespecified subgroup)
- East Asians: HR 0.35 (95% CI 0.25-0.49), P < 0.00001, I2 = 0%
- Non-East Asians: HR 0.63 (95% CI 0.43-0.93), P = 0.02, I2 = 44%
- Interaction P = 0.02
MACCE by abbreviation strategy (prespecified subgroup)
- Intensive abbreviation (≤1-week DAPT or clopidogrel/aspirin monotherapy): HR 1.37 (95% CI 1.11-1.69), P = 0.003, I2 = 0%
- Moderate abbreviation (≥2-week DAPT, then ticagrelor/prasugrel monotherapy): HR 0.96 (95% CI 0.85-1.08), P = 0.47, I2 = 0%
- P for interaction = 0.003
Original publication
Ultrashort vs Standard-Duration Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing PCI: A Meta-Analysis. JACC Cardiovasc Interv. Published 14 September 2026. doi:10.
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