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. 2025 Aug 30:S0735-1097(25)07548-5.
doi: 10.1016/j.jacc.2025.08.040. Online ahead of print.

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

Raffaele Piccolo  1 , Paolo Calabrò  2 , Greta Carrara  3 , Fiorenzo Simonetti  1 , Attilio Varricchio  4 , Tiziana Attisano  5 , Giovanni Napolitano  6 , Ciro De Simone  7 , Gerardo Carpinella  8 , Eugenio Stabile  9 , Plinio Cirillo  1 , Luigi Di Serafino  1 , Gianluca Caiazzo  10 , Tullio Tesorio  11 , Marco Boccalatte  12 , Bernardino Tuccillo  13 , Marisa Avvedimento  1 , Attilio Leone  1 , Gennaro Galasso  14 , Arturo Cesaro  2 , Rocco Perrotta  15 , Tullio Niglio  4 , Domenico Simone Castiello  1 , Maddalena Immobile Molaro  1 , Luca Bardi  1 , Alessandra Spinelli  1 , Stefano Cristiano  1 , Michele Bellino  14 , Sergio Leonardi  16 , Simone Biscaglia  17 , Francesco Costa  18 , Salvatore Cassese  19 , Eugene McFadden  20 , Dik Heg  21 , Giulio G Stefanini  22 , Anna Franzone  1 , Davide Capodanno  23 , Giovanni Esposito  24 ; PARTHENOPE Study Group
Collaborators, Affiliations

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

Raffaele Piccolo et al. J Am Coll Cardiol. .

Abstract

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).

Keywords: bleeding risk; dual antiplatelet therapy; ischemic risk; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures This investigator-initiated study was supported by the sponsoring institution, the Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. Dr Piccolo has received personal fees from Abiomed outside the submitted work. Dr Capodanno has received honoraria from Novo Nordisk. Dr Esposito has received personal fees from Abbott Vascular, Amgen, Edwards Lifesciences, and Sanofi, outside the submitted work; and has received institutional research grants from Alvimedica and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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