Abbreviated dual antiplatelet therapy after percutaneous coronary intervention with drug coated balloons in acute coronary syndromes: insights from the SWEDEHEART registry

The absence of stent implantation when using drug-coated balloons (DCBs) may decrease the required duration of dual antiplatelet therapy (DAPT). In the light of this, this study aimed to evaluate outcomes for patients with acute coronary syndromes (ACSs) treated with abbreviated vs. standard DAPT after DCB-only percutaneous coronary intervention (PCI).

Patients enrolled in the SWEDEHEART registry between June 2013 and February 2022, treated exclusively with DCBs for ACS, were included. Only patients discharged with ticagrelor as the P2Y12-receptor inhibitor were included. Patients were categorized by intended DAPT duration at discharge. The primary outcome was net adverse clinical events (NACE) at 1 year from discharge date, defined as the first occurrence of all-cause death, stroke, myocardial infarction, or major bleeding. The primary analysis used inverse-probability-of-treatment-weighted Cox regression. Among 1128 patients (141 abbreviated DAPT, 986 standard DAPT), NACE occurred in 25 patients (crude 17.7%; weighted 17.8%) in the abbreviated-DAPT arm and 133 patients (crude 13.5%; weighted 13.8%) in the standard-DAPT arm, corresponding to a weighted hazard ratio of 1.29 (95% confidence interval 0.81–2.03; P = 0.28). Results were consistent across pre-specified sensitivity analyses. Due to the small sample size, variance was generally high.

In this nationwide registry-based analysis, abbreviated DAPT following DCB-only PCI in ACS was not associated with a statistically significant difference in NACE. However, the confidence intervals were wide and did not exclude clinically meaningful harm. The findings should be regarded as hypothesis-generating and indicate the need for more comprehensive evidence before abbreviated DAPT is routinely adopted in this setting.