Personalized or Standard Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention The PARTHENOPE Randomized Trial

BACKGROUND Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain. OBJECTIVES The authors performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3, 6, or 24 months with a standard duration of DAPT for 12 months after PCI. METHODS We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary endpoint was a net adverse clinical event (NACE) at 24 months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium criteria. RESULTS At 24 months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points; 95% CI:-6.99 to-0.99; P = 0.040). This difference was mainly related to decreased rates of myocardial infarction (difference,- 2.29 percentage points; 95% CI:-4.43 to-0.14) and urgent target vessel revascularization (difference,- 1.30 percentage points; 95% CI:-2.55 to-0.05). Bleeding occurred at similar rates between the 2 groups (difference,- 0.41 percentage points; 95% CI:-2.92 to 2.10). CONCLUSIONS In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of NACE than standard care consisting of 12 months of DAPT. (Personalized Vs. Standard Duration of Dual Antiplatelet Therapy and New-generation Polymer-Free vs-Biodegradable-Polymer DES [PARTHENOPE]; NCT04135989) (JACC. 2025;86:2352-2367) (c) 2025 by the American College of Cardiology Foundation.