Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials

Abstract

Background Diabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant. Objective The purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation. Methods We searched PubMed, Embase, and the Cochrane Library for studies that compared short-term (≤ 6 months) and long-term (≥ 12 months) DAPT in patients with DM. The primary endpoints were late (31–365 days) and very late (> 365 days) stent thrombosis (ST). The secondary endpoints included myocardial infarction (MI), target vessel recanalization (TVR), all-cause death, and major bleeding. Results Six randomized controlled trials, with a total of 3,657 patients with DM, were included in the study. In terms of the primary endpoint, there was no significant difference between the two groups in late (OR 1.15, 95% CI: 0.42–3.19, P = 0.79) or very late (OR 2.18, 95% CI: 0.20–24.18; P = 0.53) ST. Moreover, there was no significant difference in the secondary endpoints, including MI (OR 1.11, 95% CI: 0.72–1.71, P = 0.63), TVR (OR 1.31, 95% CI: 0.82–2.07, P = 0.26), all-cause death (OR 1.03, 95% CI: 0.61–1.75, P = 0.90) and major bleeding (OR 1.07, 95% CI: 0.34–3.40, P = 0.90) between the two groups. Conclusion Our study demonstrated that compared with long-term DAPT, short-term DAPT had no significant difference in the clinical outcomes of patients with DM implanted with second-generation DES.

Short Versus Long Duration of Dual Antiplatelet Therapy After Second-Generation Drug-Eluting Stents Implantation in Patients with Diabetes

“…No significant difference was found in the primary end point and secondary end point points, including ST, TVR, MI, stroke, and overall mortality. This is found to be consistent with the previously conducted trials, such as those of by Sharma et al 1 and Zhang et al, 18 which primarily focused on the diabetic patients and established that there was no significant difference in clinical outcomes like MI, ST, TVR, and mortality between 2 treatment groups. The ITALIC trial, 11 in which one-third of the population had diabetes, reported the percentage of the primary end point at 1.5% and 1.6% comparing 6 and 12 months.…”

“…Therefore, it is imperative to establish an appropriate duration of DAPT in the diabetic population to optimize the safety profile and decrease the risk of bleeding associated with DAPT without compromising the efficacy of second-generation DES for coronary artery disease (CAD). 18…”

“…Therefore, it is imperative to establish an appropriate duration of DAPT in the diabetic population to optimize the safety profile and decrease the risk of bleeding associated with DAPT without compromising the efficacy of second-generation DES for coronary artery disease (CAD). 18 Comparing the results of short DAPT with long DAPT duration in our analysis, we determined short DAPT duration to be noninferior compared with longer DAPT strategy. No significant difference was found in the primary end point and secondary end point points, including ST, TVR, MI, stroke, and overall mortality.…”

A novel de-escalation antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…Cox regression analysis revealed that age, previous myocardial infarction, previous revascularization, and a history of cerebrovascular disease were independent predictors of MACCEs. Patients with previous myocardial infarction were included in the PRODIGY [27] and the PEGASUS-TIMI 54 [28] studies to explore the application duration and DAPT regimen, and they showed that prolonged DAPT was associated with a reduction in major adverse cardiovascular events. Additionally, the DAPT study [29] established the PARIS-CTE [30] and the OPT-CAD [31] DAPT scores.…”