The optimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) remains a subject of clinical debate. A new randomised trial, PARTHENOPE (NCT04135989), suggests that personalising the duration of DAPT based on a clinical risk score reduces the risk of net adverse clinical events compared to a standard 12-month course of treatment.¹
The PARTHENOPE trial was a randomised study that enrolled 2,107 patients undergoing PCI. Participants were randomly assigned to one of two groups: a personalised DAPT strategy or a standard 12-month DAPT regimen. In the personalised group, the duration of DAPT was determined by a risk score, resulting in a treatment course of 3, 6, or 24 months.
The primary endpoint was the incidence of a net adverse clinical event (NACE) at 24 months. NACE was a composite of all-cause death, myocardial infarction (MI), stroke, urgent target vessel revascularisation, or bleeding (type 2, 3, or 5 according to the Bleeding Academic Research Consortium [BARC] criteria).
At the 24-month follow-up, the primary endpoint occurred in 18.6% of patients (196 of 1,055) in the personalised DAPT group, compared to 22.2% (232 of 1,052) in the standard DAPT group. This represented a statistically significant difference of -3.54 percentage points (95% CI: -6.99 to -0.99; p=0.040).
The reduction in NACE was primarily driven by lower rates of MI (difference, -2.29 percentage points; 95% CI: -4.43 to -0.14) and urgent target vessel revascularisation (difference, -1.30 percentage points; 95% CI: -2.55 to -0.05). Importantly, the rates of bleeding events were similar between the two groups (difference, -0.41 percentage points; 95% CI: -2.92 to 2.10), indicating that the personalised approach did not increase bleeding risk.
These findings support a tailored approach to DAPT duration after PCI, moving away from a one-size-fits-all 12-month standard that is often recommended in guidelines.² By using a clinical risk score to guide treatment length, clinicians may be able to reduce ischaemic events without compromising patient safety regarding bleeding.
The study authors concluded that “in patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of NACE than standard care consisting of 12 months of DAPT.”¹
References
1. Piccolo R, Calabrò P, Carrara G, et al. Personalized or Standard Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: The PARTHENOPE Randomized Trial. JACC. 2025;86(23):2352-2367. https://doi.org/10.1016/j.jacc.2025.08.040
2. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720-3826. https://doi.org/10.1093/eurheartj/ehad191
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