Heart: Italian study revolutionizes standard of care post-angioplasty

A new Italian study revolutionizes the standard of care for patients who have undergone coronary angioplasty, demonstrating safety and efficacy of a personalized pharmacological approach. The all-Campania research team, coordinated by Giovanni Esposito, president of the School of Medicine at Federico II University, found that dual antiplatelet therapy (DAPT), which is usually prescribed for 12 months, is more effective when administered "tailor-made" for a period ranging from 3 to 24 months.

The results of the PARTHENOPE study were published in the Journal of the American College of Cardiology, along with an editorial highlighting its value and clinical implications. The work was also recently discussed at the annual meeting of the European Society of Cardiology (ESC), held in Madrid, and presented by Raffaele Piccolo, director of the School of Specialization in Diseases of the Cardiovascular System at Federico II University.

"DAPT is a pharmacological treatment that combines two antiplatelet drugs, usually aspirin and a P2Y12 receptor inhibitor," Esposito explained. "It is prescribed to patients who have undergone coronary angioplasty, a minimally invasive procedure that is used to restore blood flow to the heart by dilating coronary arteries narrowed or obstructed by atherosclerotic plaque. DAPT is used after surgery to prevent the formation of blood clots that could clog the blood vessels again. Generally, in the vast majority of patients, the duration of this therapy is 12 months. The PARTHENOPE study challenges this treatment strategy, demonstrating the effectiveness of a personalized approach."

The study, which involved more than 2,100 patients, is the first randomized trial to compare the two approaches: on the one hand, the standard strategy, i.e., DAPT for 12 months, regardless of the patient's condition; on the other hand, a personalized strategy, in which the duration of DAPT was adjusted according to the patient's "DAPT score" and clinical presentation (acute or chronic coronary syndrome).

The "DAPT score" (Dual Antiplatelet Therapy Score) is a clinical tool that assesses the risk-benefit ratio of continuing DAPT for a prolonged period, usually beyond 12 months after stent implantation.

"The results of our work were striking," Esposito points out, "The personalized strategy resulted in a 20 percent reduction in the risk of net clinical adverse events (NACE), such as death, myocardial infarction, stroke, or major bleeding over a two-year period. The main benefit was a reduction in myocardial infarctions and urgent revascularizations, without an increased risk of bleeding."

The researchers therefore concluded that, in a heterogeneous population of patients undergoing coronary angioplasty, a personalized approach to the duration of DAPT offers a superior net clinical benefit compared with the standard approach. "This finding marks an important step forward in cardiovascular medicine, shifting the focus from a one-size-fits-all protocol to more targeted care based on individual patient needs," Esposito concludes.

I thank the patients and all the professionals who made this achievement possible, which represents a milestone of great significance for the Italian and, in particular, Campania cardiology and scientific community. Our results confirm two key aspects: the winning therapies are the personalized ones and the Campania centers, when they network, manage to produce scientific evidence of the highest level."

Link to publications:

https://www.jacc.org/doi/10.1016/j.jacc.2025.08.040

https://www.jacc.org/doi/10.1016/j.jacc.2025.08.045