Personalized or Standard Duration of Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: PARTHENOPE Randomized Trial

Background: Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain. Objectives: We performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3-, 6-, or 24-months with a standard duration of DAPT for 12 months after PCI. Methods: We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary end point was a net adverse clinical end point (NACE) at 24-months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium (BARC) criteria. The trial was registered in ClinicalTrials.gov (NCT04135989) RESULTS: At 24-months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points, 95% confidence interval [CI], -6.99 to -0.99; P=0.040). This difference was mainly related to decreased rates of myocardial infarction (difference, -2.29 percentage points, 95% CI, -4.43 to -0.14) and urgent target-vessel revascularization (difference, -1.30 percentage points, 95% CI, -2.55 to -0.05). Bleeding occurred at similar rates between the two groups (difference, -0.41 percentage points; 95% confidence interval [CI], -2.92 to 2.10). Conclusions: In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of net adverse clinical events than standard care consisting of 12 months of DAPT.