Highlights of ESC Congress 2021: Master DAPT

In a Hot Line session of 28th August, Professor Marco from Switzerland presented results from the investigator-initiated, open-label MASTER DAPT trial comparing an abbreviated vs. a standard duration of antiplatelet therapy after bioresorbable polymer-coated sirolimus-eluting stent implantation in patients with acute or chronic coronary syndrome who fulfilled one or more high bleeding-risk criteria. Following a mandatory 30-day DAPT run-in phase after percutaneous coronary intervention (PCI), eligible patients who were free from ischaemic and bleeding events were randomized 1:1 to receive abbreviated or standard DAPT. Abbreviated treatment comprised single antiplatelet therapy until study completion, except for patients receiving clinically indicated oral anticoagulation, who continued single antiplatelet therapy up to 6 months after PCI. Standard treatment comprised DAPT continuation for at least 5 additional months (6 months after PCI) or, for those receiving clinically indicated oral anticoagulation, for at least 2 additional months (3 months after PCI) and with continuation thereafter of single antiplatelet therapy. The three ranked coprimary outcomes were: 1) net adverse clinical events (the composite of all-cause death, myocardial infarction [MI], stroke, and major or clinically relevant non-major bleeding); 2) major adverse cardiac and cerebrovascular events (MACCE), the composite of all-cause death, MI, and stroke) 3) major or clinically relevant non-major bleeding occurring between randomization and 335 days, defined as Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. A total of 4,579 patients from 30 countries were randomized at a median of 34 days after PCI. The mean age was 76 years, 69.3% were men, 36.2% were receiving concomitant oral anticoagulation, and 48.3% underwent PCI for the acute coronary syndrome (ACS). There was a mean of 2.1 high bleeding-risk criteria per patient. The Abbreviated DAPT was found to be non-inferior to standard DAPT in terms of net adverse clinical events and major adverse cardiac and cerebrovascular events with. [HR] 0.97 & HR 1.02 respectively with risk difference of 0.11 percentage points Abbreviated DAPT was superior to standard DAPT in terms of major or clinically relevant non-major bleeding events (6.5% vs. 9.4%, respectively; HR 0.68; 95% CI 0.55 to 0.84; p<0.001 for superiority), with a risk difference of −2.82 percentage points (95% CI −4.40 to –1.24). After PCI in patients at high risk for bleeding & clinical or angiographic high ischaemic risk DAPT of 1 month can reduce bleeding risk and provide similar low post-procedural ischaemic events as standard DAPT Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.