Key Points:
- The optimal duration and choice of dual antiplatelet therapy (DAPT) after one year for patients with multivessel disease who undergo percutaneous coronary intervention (PCI) (MVD) remains uncertain.
- The DAPT-MVD trial, a large-scale multicenter randomized study in China, found that extending DAPT with aspirin and clopidogrel for an additional year after drug-eluting stent (DES) implantation significantly reduced major adverse cardiac and cerebrovascular events (MACCE) compared to aspirin alone, without increasing bleeding.
DAPT reduces ischemic risk after PCI, but prolonged therapy may expose patients to a higher bleeding risk for a longer period of time. Patients with MVD at the time of PCI have an increased risk for ischemic events compared to those with single vessel disease, however whether prolonged DAPT beyond one year improves outcomes in this population remains uncertain.
On November 8th, 2025, the preliminary results of “Efficacy and Safety of Extended Dual Antiplatelet Therapy in Stable Patients with Multivessel Coronary Artery Disease Undergoing Drug-Eluting Stent Implantation (DAPT-MVD)” were presented at the American Heart Association Scientific Sessions in New Orleans, LA. The purpose of this trial was to evaluate the efficacy and safety of extended DAPT among patients with MVD who underwent DES and tolerated DAPT for 12 months.
This investigator-initiated, multicenter, open-label, assessor-masked superiority trial in China randomized 8250 participants with MVD who underwent DES and tolerated DAPT for 12 months without major ischemic or bleeding events in a 1:1 ratio to either receive an additional 12 months of DAPT with aspirin and clopidogrel or aspirin alone. The primary efficacy outcome was a composite of MACCE (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). The primary safety outcome was Bleeding Academic Research Consortium (BARC) types 2-5 bleeding. Enrollment occurred between October 2020 and March 2024, exclusively in China.
Overall, the mean age was 61 years, 30% were female, and 28% had diabetes. Drop-out rates were low – 98.1% completed following up, with a median duration of 34.3 months. Participants randomized to extended DAPT had a significantly lower rate of MACCE compared to those in the aspirin monotherapy arm (5.8% vs. 6.8% at 36 months; HR 0.82 [95% CI: 0.69, 0.98]), while there was no significant difference in BARC type 2-5 bleeding (1.4% vs. 1.5%; HR 0.89 [95% CI: 0.61, 1.30]). The reduction in MACCE was primarily driven by a reduction in myocardial infarction. Stent thrombosis was rare, with only 2 stent thrombosis events in the entire study population. Results were consistent across subgroup analysis, except for a potential signal for lower benefit among those with a higher body mass index.
Limitations of this study include lack of assessment of the baseline bleeding risk by any of the established scoring methods – though the low observed bleeding rates indicate this was a low bleeding risk population. Generalizability is limited as the trial was performed exclusively in China. In addition, the mean body mass index in China is lower than in western populations, which may be relevant given the signal for worse outcomes in those with a higher body mass index. Given the growing evidence for de-escalation of DAPT to P2Y12 monotherapy instead of aspirin monotherapy, it remains uncertain whether there is a role for continuing clopidogrel alone after 12 months of DAPT in this high ischemic risk population.
Dr. Xiang Peng of the Harbin Medical University in Harbin, China concluded: “Extending DAPT in stable patients for an additional 12-month post-DES implantation reduces the risk of MACCE without increasing bleeding risk.”
