Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.243
Peer-review started: March 15, 2021
First decision: April 26, 2021
Revised: May 19, 2021
Accepted: July 26, 2021
Article in press: July 26, 2021
Published online: August 26, 2021
Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy (DAPT) to reduce stent thrombosis and avoid target lesion failure. The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome, and 6 mo for patients with chronic coronary syndrome or high bleeding risk. The new generation of drug-eluting stents have metallic platforms with thinner struts, associated with significantly less stent thrombosis. Shortened DAPT has been investigated with these stents, with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes. This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations. This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.
Core Tip: The new generation of drug-eluting stents have different properties such as reduced strut thickness allowing lower level of local stent thrombosis, which may be feasible with shortened dual antiplatelet therapy (DAPT). Only a small number of individual stents have been validated for reduced DAPT, such as 1 mo for the BioFreedom stainless steel biolimus-eluting stent and the Onyx Resolute cobalt-chromium zotarolimus-eluting stent but in only certain populations. Future trials will compare DAPT durations within the same stent. Future research should also examine risk stratification and the parameters for patients to benefit the most from shortened DAPT.