Dual Antiplatelet Therapy Beyond 1-year after Percutaneous Coronary Interventions for Stable Coronary Artery Disease Results in Harm

The benefit of extended dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. The ARTIC-Interruption Trial examined discontinuation of DAPT at 1-year after PCI vs continuation for an additional 6–18 months. The study randomized patients 1-year after PCI to continuation (N=635) or interruption (N=624) groups, and examined the primary composite endpoint of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization over a median follow-up of 17 months. No significant differences were observed between the treatment groups for the primary outcome (hazard ratio [HR] 1.17; 95% confidence interval [CI] 0.68–2.03]; p=0.58). Bleeding events (as defined by STEEPLE criteria) occurred significantly more frequently in the continuation group (HR 0.26; 95% CI 0.07–0.91; p=0.04) when major and minor bleeding events were combined. As this study was a follow on to an evaluation of antiplatelet regimens guided by platelet reactivity at the time of index PCI, there was variation in the type of DAPT between patients at randomization for this study. Furthermore, there was crossover between treatment arms that was not evaluated with an on-treatment …