Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Table 1 Current stents categorised by stent material, polymer, eluted drug, and shortened dual antiplatelet therapy duration validated for followed by aspirin or P2Y12 inhibitor monotherapy

Stent	Metallic platform	Polymer	Anti-proliferative agent	DAPT duration validated for	Ref.
Onyx Resolute	Cobalt-chromium (has a platinum iridium core)	Permanent	Zotarolimus	1 mo	[5,6]
BioFreedom	Stainless steel	Polymer-free	Biolimus	1 mo1	[7,8]
Biomatrix; Biomatrix Flex	Cobalt-chromium	Bioresorbable	Biolimus	Standard/no short DAPT	[9,10]
Nobori	Cobalt-chromium	Bioresorbable	Biolimus	6 mo	[11]
Xience	Cobalt-chromium	Permanent	Everolimus	1-3 mo2	[12,13]
EluNIR	Cobalt-chromium	Permanent	Ridaforolimus	Standard/no short DAPT	[14]
Ultimaster; Orsino	Cobalt-chromium	Permanent	Sirolimus	Standard/no short DAPT	[15,16]
Cre8	Cobalt-chromium	Polymer-free	Amphilimus	Standard/no short DAPT	[17]
Xposition S (self-apposing)	Nickel-titanium	Permanent	Silolimus	Standard/no short DAPT	[18]
Promus	Platinium-chromium	Bioresorbable	Everolimus	6 mo	[12]
Synergy	Platinium-chromium	Bioresorbable	Everolimus	3 mo1	[19]

If there was no randomised control trial or prospective trial with a paired control investigating dual antiplatelet therapy (DAPT) duration, DAPT duration validated for is put down as ‘standard/no short DAPT.

¹All trials examined both acute coronary syndrome and chronic coronary syndromes, though the EVOLVE Short DAPT study and the One-Month DAPT trial did not include patients with myocardial infarction.

²The STOPDAPT-2 trial examined 1-mo DAPT followed by P2Y12 inhibitor therapy. DAPT: Dual antiplatelet therapy.

Table 2 Summary of evidence of shortened dual antiplatelet therapy duration for specific stents from randomised control trials and single-arm prospective studies with a historical control

	Population	Study	Intervention	Control	Primary endpoint
Single-arm study	ACS (32%) and CCS (68%)	STOPDAPT[28]	1525 patients, XIENCE CoCr-EES with 3-mo DAPT followed by aspirin monotherapy	1559 patients, Endeavor CoCr-EES approximately 90% with 1-yr DAPT followed by aspirin monotherapy (RESET trial)	12-mo cardiovascular death, MI, stroke, thrombosis, bleeding; 2.8% vs 4.0% (P = 0.06)
	No acute myocardial infarction, High bleeding risk	EVOLVE Short DAPT[19]	1487 patients, SYNERGY stent with 3-mo DAPT followed by aspirin monotherapy	1493 patients, 1-year DAPT	3-15 mo death or MI; 5.6% vs 5.7% (P = 0.0016 non-inferiority)
RCT	ACS (38%) and CCS (62%)	STOPDAPT-2[29]	1523 patients, XIENCE CoCr-EES with 1-mo DAPT followed by clopidogrel monotherapy	1522 patients, XIENCE CoCr-EES with 12-mo DAPT	12-mo Cardiovascular death, MI, stroke, thrombosis, bleeding; 2.36% vs 3.70% (superiority P = 0.04)
	ACS (42%) and CCS (58%); High bleeding risk	LEADERS FREE I[7]	1196 patients, BioFreedom DES with 1-month DAPT followed by one antiplatelet	1189 patients, Gazelle uncoated BMS with 1-month DAPT followed by one antiplatelet	390 d cardiovascular death, MI, stent thrombosis 9.4% vs 12.9% (P = 0.005 superiority)
	No acute myocardial infarction	One-month DAPT trial[8]	1507 patients, BioFreedom DES with 1-mo DAPT followed by aspirin monotherapy	1513 patients, BioMatrix and Ultimaster DES with 6-12 mo DAPT	12-mo cardiovascular death, MI, target vessel revasculariation, stroke, major bleeding; 5.9% vs 6.5% (noninferority P < 0.001)
	ACS (62%) and CCS (38%)High bleeding risk	ONXY ONE Global[5]	1003 patients, Resolute Onyx DES with 1-mo DAPT followed by one antiplatelet	993 patients, BioFreedom DES with 1-mo DAPT followed by one antiplatelet	Cardiac death, MI, thrombosis 17.1% vs 16.9% (P = 0.011 noninferiority)

ACS: Acute coronary syndrome; DAPT: Dual antiplatelet therapy; CoCr-EES: Everolimus-eluting cobalt-chromium stent; DES: Drug-eluting stents; MI: Myocardial infarction.