SMART-DATE Trial (2018): 6 vs 12 months of DAPT after PCI with DES in ACS

SMART-DATE trial summary

The SMART-DATE trial tested the hypothesis as to whether 6 months of dual antiplatelet therapy (DAPT) is non-inferior to 12 months of DAPT in patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and require DAPT. Source

SMART-DATE Trial Key Points:

6 months DAPT was found to be noninferior in terms of major cardiovascular events (MACCE). However, myocardial infarction was found to be more recurrent in patients undergoing a shorter duration of DAPT compared to complete 12 months.

The SMART-DATE trial tested the shorter duration and is comparable to DAPT trial which tested 18 months duration of DAPT versus 12 months standard management.

Guidelines based on SMART-DATE trial

The last ACC/AHA guidelines were before this trial and recommends:

Complete 12 months of DAPT in patients who underwent PCI with either DES or BMS. (recommendation: 1a, LOE: A)

For patients who have complications such as bleeding, guidelines recommend that DAPT can be discontinued after 6 months.
(recommendation: IIa)

For patients at low risk of bleeding, DAPT can be continued beyond 12 months. (recommendation: IIa)