Objective:
The aim was to evaluate the efficacy and safety of duration of dual antiplatelet therapy
(DAPT) for patients who received percutaneous coronary intervention (PCI) with a drug-eluting stent.
Background:
The optimal duration of DAPT to balance the risk of ischemia and bleeding in CAD patients undergoing
drug-eluting stent (DES) implantation remains controversial.
Methods:
PubMed, Cochrane Library, Web of Science, Clinicaltrials.gov, CNKI and Wanfang Databases were
searched for randomized controlled trials of comparing different durations of DAPT after DES implantation.
Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), and major bleeding, and
were pooled by Bayes network meta-analysis. Net adverse clinical and cerebral events were used to estimate the
surface under the cumulative ranking (SUCRA) curves. The subgroup analysis based on clinical status, follow-up
and area was conducted using traditional pairwise meta-analysis.
Results:
A total of nineteen trials (n=51,035) were included, involving six duration strategies. The network metaanalysis
showed that T2 (<6-month DAPT followed by aspirin, HR:1.51, 95%CI:1.02-2.22), T3 (standard
6-month DAPT, HR:1.47, 95%CI:1.14-1.91), T4 (standard 12-month DAPT, HR:1.41, 95%CI:1.15-1.75) and T5
(18-24 months DAPT, HR:1.47, 95%CI:1.09-1.97) was associated with significantly increased risk of MACCE
compared to T6 (>24-month DAPT). However, no significant difference was found in MACCE risk between T1
(<6-month DAPT followed by P2Y12 monotherapy) and T6. Moreover, T5 was associated with significantly
increased risk of bleeding compared to T1(RR:3.94, 95%CI:1.66-10.60), T2(RR:3.65, 95%CI:1.32-9.97),
T3(RR:1.93, 95%CI:1.21-3.50) and T4(RR:1.89, 95%CI:1.15-3.30). The cumulative probabilities showed that
T6(85.0%), T1(78.3%) and T4(44.5%) were the most efficacious treatment compared to the other durations. In
the ACS (<50%) subgroup, T1 was observed to significantly reduce the risk of major bleeding compared to T4,
but not in the ACS (≥50%) subgroup.
Conclusions:
Compared with other durations, short DAPT followed by P2Y12 inhibitor monotherapy showed
non-inferiority, with a lower risk of bleeding and not associated with an increased MACCE. In addition, the risk
of major bleeding increased significantly, starting with DAPT for 18-month. Compared with the short-term treatment,
patients with ACS with the standard 12-month treatment have a better prognosis, including lower bleeding
rate and the decreased risk of MACCE. Due to study's limitations, the results should be verified in different risk
populations.
The saga of the duration of dual antiplatelet therapy after drug-eluting stent placement
