Valgimigli, MarcoMarcoValgimigliSmits, Pieter CPieter CSmitsFrigoli, EnricoEnricoFrigoliBongiovanni, DarioDarioBongiovanniTijssen, JanJanTijssenHovasse, ThomasThomasHovasseMafragi, AlAlMafragiRuifrok, W TW TRuifrokKarageorgiev, DimitarDimitarKarageorgievAminian, AdelAdelAminianGarducci, StefanoStefanoGarducciMerkely, BelaBelaMerkelyRoutledge, HelenHelenRoutledgeAndo, KenjiKenjiAndoFernandez, Josè Francisco DiazJosè Francisco DiazFernandezCuisset, ThomasThomasCuissetMalik, Fazila Tun NesaFazila Tun NesaMalikHalabi, MajdiMajdiHalabiBelle, LoicLoicBelleDin, JehangirJehangirDinBeygui, FarzinFarzinBeyguiAbhyankar, AtulAtulAbhyankarReczuch, KrzysztofKrzysztofReczuchPedrazzini, GiovanniGiovanniPedrazziniHeg, Dierik HansDierik HansHeg0000-0002-8766-7945Vranckx, PascalPascalVranckx2024-10-112024-10-112022-09-01https://boris-portal.unibe.ch/handle/20.500.12422/85135AIMS To assess the effects of 1- or ≥3-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients who received biodegradable-polymer sirolimus-eluting stents for complex percutaneous coronary intervention (PCI) and/or acute coronary syndrome (ACS). METHODS AND RESULTS In the MASTER DAPT trial, 3383 patients underwent noncomplex (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 complex (abbreviated DAPT, n = 588; standard DAPT, n = 608) PCI. Co-primary outcomes at 335 days were net adverse clinical events (NACE; composite of all-cause death, myocardial infarction, stroke, and Bleeding Academic Research Consortium [BARC] 3 or 5 bleeding events); major adverse cardiac or cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and type 2, 3, or 5 BARC bleeding.NACE and MACCE did not differ with abbreviated versus standard DAPT among patients with complex (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively) and noncomplex PCI (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; Pinteraction = 0.60 and 0.26, respectively). BARC 2, 3 or 5 was reduced with abbreviated DAPT in patients with and without complex PCI (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55-0.89; Pinteraction = 0.72). Among the 2,816 patients with complex PCI and/or ACS, NACE and MACCE did not differ and BARC 2, 3 or 5 was lower with abbreviated DAPT. CONCLUSION In HBR patients free from recurrent ischemic events at 1 month, DAPT discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity.enPercutaneous coronary intervention complex intervention dual antiplatelet therapy high bleeding risk600 - Technology::610 - Medicine & healtharticle10.48350/1700913558083610.1093/eurheartj/ehac284