Short-Term DAPT After Complex PCI With Third-Generation DES: A Post Hoc Analysis of the HOST-IDEA Trial

BACKGROUND: The optimal duration of dual antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We aim to investigate the efficacy and safety of 3 to 6 months of dual antiplatelet therapy over 12 months after complex PCI. METHODS: A post hoc analysis of the HOST-IDEA (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy) randomized trial which enrolled patients undergoing PCI with third-generation drug-eluting stents was performed. Complex PCI was defined by any of the following: ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI with 2-stenting, total stent length ≥60 mm, left main PCI, or heavy calcification. The major end points were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization for ischemic outcomes, and major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, for bleeding outcomes at 12 months. RESULTS: Among 1992 patients, 624 underwent complex PCI. The complex PCI group had clinical features associated with high bleeding risk. A shortened dual antiplatelet therapy duration did not increase the risk of target lesion failure, with hazard ratios of 0.818 (95% CI, 0.403–1.659) for the complex PCI group and 1.282 (95% CI, 0.506–3.249) for the noncomplex PCI group ( P interaction =0.451). Conversely, it decreased the risk of major bleeding in the complex PCI group (hazard ratio, 0.269 [95% CI, 0.075–0.965]), but not in the noncomplex PCI group (hazard ratio, 1.534 [95% CI, 0.627–3.754], showing a significant interaction; P interaction =0.029). CONCLUSIONS: In patients undergoing complex PCI with a third-generation drug-eluting stent, a 3- to 6-month duration of dual antiplatelet therapy was associated with a reduced risk of bleeding without an increased risk of ischemic events compared with 12-month dual antiplatelet therapy. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02601157.