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Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk : a MASTER DAPT trial sub-analysis.

1/10/2022 -  


Patients undergoing percutaneous coronary intervention (PCI) with severe coronary artery disease (CAD) and challenging lesion subsets require complex procedures and remain at increased risk of short and long-term adverse ischaemic events. 

MASTER DAPT  was an investigator‑initiated, randomised, open‑label trial conducted in patients at high bleeding risk after the implantation of an Ultimaster™/Ultimaster™ Tansei™ DES. 

The trial compared abbreviated (1 month) dual antiplatelet therapy (DAPT) with non-abbreviated (3-12 months) DAPT. 

The primary results showed that 1 month of DAPT was non-inferior to treatment continuation for at least 2 additional months for the occurrence of net adverse clinical events (NACE) and major adverse cardiac and cerebral events (MACCE) and reduced major or clinically relevant non-major bleeding (MCB) in the overall high bleeding risk population. 


The aim of this prespecified subgroup analysis was to assess the consistency of the treatment effects of 1-month vs. a more prolonged DAPT duration based on PCI and patient (complex PCI and/or acute coronary syndrome (ACS)) complexity.

Complex PCI was defined as 3-vessels treated, ≥ 3 stents implanted, ≥3 lesions treated, bifurcation with two stents implanted, total stent length > 60 mm, or chronic total occlusion (CTO).


Source: Valgimigli et al. Eur Heart J. 2022


Patients randomized to an abbreviated or a non-abbreviated DAPT regimen were grouped according to the presence of complex PCI features and/or ACS.


Source: Valgimigli et al. Eur Heart J. 2022


  • No interaction between the three ranked primary endpoints and complex PCI and/or ACS.


Source: Valgimigli et al. Eur Heart J. 2022

Source: Valgimigli et al. Eur Heart J. 2022


One-month DAPT after PCI with the Ultimaster™ Family DES in high bleeding risk patients was associated with:
  • Similar net adverse clinical events (NACE)
  • Similar major adverse cardiac or cerebral events (MACCE)
  • Lower bleeding rates (MCB)

Key Takeaways

In high bleeding risk patients undergoing PCI without recurrent ischemic events in the first 30 days after coronary intervention, PCI complexity and/or ACS does not justify a DAPT regimen longer than one month.

Link to the full publication: