Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The optimal dual antiplatelet therapy (DAPT) duration after second-generation drug-eluting stent (DES) implantation remains unclear. We aim to evaluate the efficacy and safety of short-term (#6 months) and long-term ($12 months) DAPT after second-generation DES implantation. Methods: Randomized controlled trials (RCTs) were searched in PubMed, the Cochrane Library, the Embase and ClinicalTrials.gov in the English language. The endpoints included allcause mortality, cardiac death, non-cardiac death, myocardial infarction (MI), stent thrombosis (ST), stroke, all bleeding, and major bleeding. The effect estimate was expressed by using the hazard ratio (HR) with 95% CI and random effect models.Results: Seven RCTs with 13,571 patients were included in this study. In terms of survival endpoints, there was no significant difference in all-cause mortality (HR: 0.91; 95% CI: 0.71-1.17), cardiac death (HR: 0.93; 95% CI: 0.67-1.29), and non-cardiac death (HR: 0.89; 95% CI: 0.62-1.28) in the 2 groups. Moreover, there was no significant difference in ischemic outcomes, including MI (HR: 1.15; 95% CI: 0.91-1.45), ST (HR: 1.11; 95% CI: 0.75-1.66), and stroke (HR: 0.85; 95% CI: 0.53-1.35) in the 2 groups. In terms of bleeding endpoints, there was no significant difference in all bleeding (HR: 0.81; 95% CI: 0.64-1.04) and major bleeding (HR: 0.82; 95% CI: 0.49-1.36) in the 2 groups. The subgroup analysis showed that the proportion of patients with acute coronary syndrome was not associated with the benefit of long-term versus short-term DAPT. Conclusion: Short-term DAPT is not inferior to long-term DAPT in patients implanted with second-generation DES.

Short‐term vs long‐term dual antiplatelet therapy after drug‐eluting stent implantation in patients undergoing percutaneous coronary intervention: A systematic review and meta‐analysis

“…To our knowledge, five meta‐analyses 18‐22 have been published in recent years and they also recommended short‐term DAPT for PCI patients, which is consistent with our results. Compared with these studies, our meta‐analysis has several strengths.…”

“…Recently, a short duration of DAPT (≤6 months) followed by antiplatelet monotherapy instead of the standard 12‐month DAPT has been suggested 7‐9,16,17 . A few meta‐analyses 18‐22 have also been conducted in recent years. The meta‐analysis by Li et al 18 is very similar to our theme, but they included only seven randomised controlled trials (RCTs) and at least eleven RCTs have been completed since then.…”

“…[7][8][9]16,17 A few meta-analyses [18][19][20][21][22] have also been conducted in recent years. The meta-analysis by Li et al 18 is very similar to our theme, but they included only seven randomised controlled trials (RCTs) and at least eleven RCTs have been completed since then. Two meta-analyses 19,20 focused on P2Y12 inhibitor monotherapy vs aspirin monotherapy and Asian vs non-Asian populations.…”

Clinical Outcomes of Prolonged Antiplatelet Therapy after Percutaneous Coronary Intervention in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

“…In patients with acute coronary syndromes, short duration of DAPT was associated with an increasing risk of target vessel revascularization and lower rate of bleeding compared with long-term DAPT after DES [21][22][23]. However, there was no significant difference in the rate of all-cause mortality, cardiac mortality, and stroke [24,25]. The study to explore efficacy and safety of DAPT in CKD patients with PCI was limited.…”