Duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for bifurcation lesions: Insights from the ULTRA-BIFURCAT registry

Abstract

Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains debated, particularly for bifurcation lesions, which are associated with increased thrombotic risk. Shorter DAPT regimens may reduce bleeding but could compromise ischemic protection. Methods: This study analyzed data from the ULTRA and BIFURCAT registries, including patients treated with PCI for bifurcation lesions. Patients requiring oral anticoagulation were excluded. DAPT duration was categorized as ≤6 months, 6–12 months and > 12 months. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis. Cox regression analysis was used to assess the association between DAPT duration and MACE. Results: Among 6729 patients, 425 (6 %) received DAPT ≤6 months, 3446 (51 %) for 6–12 months and 2858 (42 %) for >12 months. At 800-day follow-up, MACE rates were higher with shorter DAPT (19.5 % vs. 10 % vs. 5.9 %, p < 0.001). Adjusted hazard ratios for MACE were significantly higher for DAPT ≤6 months (HR 4.8, 95 % CI 1.8–12.7) and 6–12 months (HR 2.7, 95 % CI:1.5–4.7) compared to >12 months. This trend was consistent in acute coronary syndrome (ACS) patients but not in stable patients. Conclusion: In PCI-treated bifurcation lesions, particularly in ACS patients, shorter DAPT duration (≤6 months) is associated with a higher risk of adverse events. These findings, albeit hypothesis generating, highlight the need to consider bifurcation lesions as a key factor in tailoring DAPT duration and may warrant confirmation in dedicated trials.