The evolution of dual antiplatelet therapy in patients with coronary artery disease.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor has been the mainstay of therapy for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) following percutaneous coronary intervention (PCI) for more than two decades. Over this period, numerous trials have evaluated different antiplatelet strategies, initially focusing on more effective and prolonged regimens, and more recently on decreasing the intensity or duration of DAPT. Despite a wealth of accumulated evidence, the optimal antiplatelet strategy-including the ideal agent, combination, or treatment duration-remains a subject of active debate. This review summarizes the evolution of antiplatelet therapy, with particular emphasis on randomized controlled trials of DAPT in patients with ACS or CCS undergoing PCI.