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

Håkansson, Anton LU orcid ; von Koch, Sacharias LU orcid ; Dahlgren, Axel LU orcid ; Reitan, Christian LU ; Koul, Sasha LU ; James, Stefan K. ; Jernberg, Tomas ; Grimfjärd, Per ; Omerovic, Elmir and Angerås, Oskar , et al. (2026) In European Heart Journal - Cardiovascular Pharmacotherapy p.1-9
Abstract
Aims
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).

Methods and results
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... (More)
Aims
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).

Methods and results
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.

Conclusion
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. (Less)
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organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
European Heart Journal - Cardiovascular Pharmacotherapy
article number
pvag032
pages
1 - 9
publisher
Oxford University Press
external identifiers
  • pmid:42095276
ISSN
2055-6837
DOI
10.1093/ehjcvp/pvag032
language
English
LU publication?
yes
id
27c563eb-a87c-4e91-8fbf-15ba39c83206
date added to LUP
2026-06-11 17:03:10
date last changed
2026-06-12 07:23:14
@article{27c563eb-a87c-4e91-8fbf-15ba39c83206,
  abstract     = {{Aims<br/>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).<br/><br/>Methods and results<br/>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.<br/><br/>Conclusion<br/>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.}},
  author       = {{Håkansson, Anton and von Koch, Sacharias and Dahlgren, Axel and Reitan, Christian and Koul, Sasha and James, Stefan K. and Jernberg, Tomas and Grimfjärd, Per and Omerovic, Elmir and Angerås, Oskar and Erlinge, David and A.Mohammad, Moman A}},
  issn         = {{2055-6837}},
  language     = {{eng}},
  month        = {{05}},
  pages        = {{1--9}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal - Cardiovascular Pharmacotherapy}},
  title        = {{Abbreviated dual antiplatelet therapy after percutaneous coronary intervention with drug coated balloons in acute coronary syndromes: insights from the SWEDEHEART registry}},
  url          = {{http://dx.doi.org/10.1093/ehjcvp/pvag032}},
  doi          = {{10.1093/ehjcvp/pvag032}},
  year         = {{2026}},
}