Paris, 23 May 2019. The final results of the REDUCE trial have been presented as Late Breaking Trial by prof. Giuseppe De Luca at the EuroPCR congres.
Evidence to support 12-month DAPT strategy in ACS is still based on a 20-year old ACS trial (PCI-CURE), in which only minor benefits in combined death and MI (0.7%) were observed during the randomised study phase. Improvement in DES technology has contributed to a faster re-endothelisation and solved all previous safety issues related to stent thrombosis with DES. The COMBO Dual Therapy Stent, which combines abluminal release of sirolimus and capture of endothelial progenitor cells may be attractive in the context of ACS.
The REDUCE trial is an investigator-initiated prospective, multicenter, randomised study with two randomisation groups (3 versus 12 months DAPT) (NCT02118870). The main objective of the trial was to evaluate the non-inferiority of a combined safety and efficacy endpoint of a short-term 3 months DAPT, compared to standard 12-month DAPT strategy, in ACS patients treated with the COMBO stent.
The results of the REDUCE trial show that among ACS patients treated with COMBO, 3 months is non-inferior to 12 months DAPT. However, given the numerically higher rates of mortality and ST in the 3 months DAPT group, 1-year DAPT should still be recommended in ACS until more information becomes available inferior to 12 months DAPT. Therefore, short-term DAPT may be considered only if clinically mandated such as in high-risk bleeding patients.