Ultra-short versus Standard-Duration Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing PCI: A Meta-Analysis (JACC Cardiovascular Interventions September 2026)-Article: Ultra-short versus Standard-Duration Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing PCI: A Meta-Analysis

Article: Ultra-short versus Standard-Duration Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing PCI: A Meta-Analysis

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This meta-analysis examined whether ultrashort dual antiplatelet therapy (DAPT), defined as 1 month or less followed by single antiplatelet therapy, is safe and effective in acute coronary syndrome (ACS) patients undergoing PCI. It pooled 10 randomized controlled trials involving 29,232 patients and compared ultrashort DAPT with standard 6–12 month DAPT over 12 months of follow-up.<br /><br />Overall, ultrashort DAPT did not increase major adverse cardiac and cerebrovascular events (MACCE) compared with standard DAPT (HR 1.06), but it significantly reduced major bleeding by about half (HR 0.47). This led to a net clinical benefit (HR 0.83). There were no significant differences in death, stroke, cardiovascular mortality, or target-vessel revascularization. However, there was a trend toward more myocardial infarction and stent thrombosis with ultrashort DAPT.<br /><br />Subgroup analyses showed important differences. In STEMI patients, ultrashort DAPT was associated with a higher MACCE risk, while no such increase was seen in NSTE-ACS. Bleeding reduction was greater in East Asian patients than in non-East Asians. The type of abbreviation strategy also mattered: very early aspirin discontinuation or switching to clopidogrel/aspirin monotherapy (“intensive” abbreviation) was linked to higher ischemic risk, whereas 2-week DAPT followed by potent P2Y12 inhibitor monotherapy (“moderate” abbreviation) appeared safer.<br /><br />The authors conclude that ultrashort DAPT can reduce bleeding without increasing overall ischemic events in ACS, but caution is warranted in STEMI and when using clopidogrel- or aspirin-based monotherapy. The most favorable balance seems to be about 1 month of DAPT followed by potent P2Y12 inhibitor monotherapy, especially ticagrelor or prasugrel.

Meta Tag

Concept Dual Antiplatelet Therapy

Concept Major Adverse Cardiovascular and Cerebrovascular Events

Concept Major Bleeding

Concept Percutaneous Coronary Intervention

Concept Acute Coronary Syndrome

Keywords

ultrashort dual antiplatelet therapy

acute coronary syndrome

percutaneous coronary intervention

major bleeding

major adverse cardiac and cerebrovascular events

stent thrombosis

myocardial infarction

East Asian patients

ticagrelor monotherapy

prasugrel monotherapy

Dual Antiplatelet Therapy

Major Adverse Cardiovascular and Cerebrovascular Events

Major Bleeding

Percutaneous Coronary Intervention

Acute Coronary Syndrome