scholarly journals Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis

BMJ ◽  
2019 ◽  
pp. l2222 ◽  
Author(s):  
Shang-He-Lin Yin ◽  
Peng Xu ◽  
Bian Wang ◽  
Yao Lu ◽  
Qiao-Yu Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Efficacy And Safety ◽  
Short Term ◽  
All Cause Mortality ◽  
Standard Term

Abstract Objective To evaluate the efficacy and safety of standard term (12 months) or long term (>12 months) dual antiplatelet therapy (DAPT) versus short term (<6 months) DAPT after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Design Systematic review and network meta-analysis. Data sources Relevant studies published between June 1983 and April 2018 from Medline, Embase, Cochrane Library for clinical trials, PubMed, Web of Science, ClinicalTrials.gov, and Clinicaltrialsregister.eu. Review methods Randomised controlled trials comparing two of the three durations of DAPT (short term, standard term, and long term) after PCI with DES were included. The primary study outcomes were cardiac or non-cardiac death, all cause mortality, myocardial infarction, stent thrombosis, and all bleeding events. Results 17 studies (n=46 864) were included. Compared with short term DAPT, network meta-analysis showed that long term DAPT resulted in higher rates of major bleeding (odds ratio 1.78, 95% confidence interval 1.27 to 2.49) and non-cardiac death (1.63, 1.03 to 2.59); standard term DAPT was associated with higher rates of any bleeding (1.39, 1.01 to 1.92). No noticeable difference was observed in other primary endpoints. The sensitivity analysis revealed that the risks of non-cardiac death and bleeding were further increased for ≥18 months of DAPT compared with short term or standard term DAPT. In the subgroup analysis, long term DAPT led to higher all cause mortality than short term DAPT in patients implanted with newer-generation DES (1.99, 1.04 to 3.81); short term DAPT presented similar efficacy and safety to standard term DAPT with acute coronary syndrome (ACS) presentation and newer-generation DES placement. The heterogeneity of pooled trials was low, providing more confidence in the interpretation of results. Conclusions In patients with all clinical presentations, compared with short term DAPT (clopidogrel), long term DAPT led to higher rates of major bleeding and non-cardiac death, and standard term DAPT was associated with an increased risk of any bleeding. For patients with ACS, short term DAPT presented similar efficacy and safety with standard term DAPT. For patients implanted with newer-generation DES, long term DAPT resulted in more all cause mortality than short term DAPT. Although the optimal duration of DAPT should take personal ischaemic and bleeding risks into account, this study suggested short term DAPT could be considered for most patients after PCI with DES, combining evidence from both direct and indirect comparisons. Systematic review registration PROSPERO CRD42018099519.

Efficacy and Safety of Adjunctive Trimetazidine Therapy for Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Cardiology ◽  
2016 ◽  
Vol 135 (3) ◽  
pp. 188-195 ◽  
Author(s):  
Yongyong Li ◽  
Dewei Wang ◽  
Chunxiao Hu ◽  
Peng Zhang ◽  
Dongying Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Adverse Events ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Short Term ◽  
All Cause Mortality ◽  
Acute Mi

Background: Several lines of evidence support the clinical use of trimetazidine as an adjunctive therapy in cardioischemic patients. Therefore, we assessed here the efficacy and safety of adjunctive trimetazidine therapy in acute myocardial infarction (MI) patients by a systematic review and meta-analysis of the current literature. Methods: PubMed, the Cochrane Library, and the China National Knowledge Infrastructure databases were searched for clinical studies comparing adjunctive trimetazidine therapy against placebo in adult acute MI patients. Several clinical outcomes [early/short-term all-cause mortality, long-term all-cause mortality, total major adverse cardiac events (MACE), recurrent nonfatal MI, in-hospital adverse events, target vessel revascularization (TVR), and coronary artery bypass graft (CABG)] were analyzed by the intention-to-treat principle. Odds ratios (OR) and their 95% confidence intervals (CI) were derived from the number of outcome events in each study arm to estimate the association between adjuvant trimetazidine administration and the various clinical outcomes. A random-effects model was applied for all meta-analyses. Results: We found that adjunctive trimetazidine therapy showed a significant effect upon total MACE (OR = 0.33, 95% CI = 0.15-0.74; p = 0.007) but showed no significant effect upon early/short-term all-cause mortality, long-term all-cause mortality, recurrent nonfatal MI, in-hospital adverse events, TVR, or CABG (p > 0.05). Conclusions: This is the first meta-analysis to report that adjunctive trimetazidine therapy has a beneficial effect upon total MACE in acute MI patients. Clinical investigators should consider further trials on adjunctive trimetazidine therapy in order to better define its risks and benefits in acute MI patients.

EP.WE.14Prognostic significance of metabolic syndrome in patients undergoing carotid artery revascularisation: A systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Adverse Events ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Long Term Outcomes ◽  
Short Term ◽  
All Cause Mortality ◽  
Major Adverse Events

Abstract Aims to evaluate prognostic significance of metabolic syndrome (MetS) in patients undergoing carotid artery revascularisation. Methods A systematic review and meta-analysis was performed in compliance with PRISMA standards to evaluate prognostic significance of MetS in patients undergoing carotid endarterectomy or carotid stenting. Short-term (&lt;30 days) postoperative outcomes (all-cause mortality, stroke or transient ischaemic attack (TIA), myocardial infarction, major adverse events) and long-term outcomes (restenosis, all-cause mortality, stroke or TIA, myocardial infarction, major adverse events) were considered as outcomes of interest. Random effects modelling was applied for the analyses. Results Analysis of 3721 patients from five cohort studies showed no difference between the MetS and no MetS groups in terms of the following short-term outcomes: all-cause mortality (OR: 1.67,P=0.32), stroke or TIA (OR: 2.44,P=0.06), myocardial infarction (OR: 1.01,P=0.96), major adverse events (OR: 1.23, P = 0.66). In terms of long-term outcomes, MetS was associated with higher risk of restenosis (OR: 1.75,P=0.02), myocardial infarction (OR: 2.12,P=0.04), and major adverse events (OR: 1.30, P = 0.009) but there was no difference between the two groups in terms of all-cause mortality (OR: 1.11, P = 0.25), and stroke or TIA (OR: 1.24, P = 0.33). The quality and certainty of the available evidence were judged to be moderate. Conclusions The best available evidence suggest that although MetS may not affect the short-term postoperative morbidity and mortality outcomes in patients undergoing carotid revascularisation, it may result in higher risks of restenosis, myocardial infarction and major adverse events in the long-term. Evidence from large prospective cohort studies are required for more robust conclusions.

scholarly journals Dual antiplatelet therapy in patients with coronary artery disease after percutaneous coronary intervention with drug-eluting stents: A systematic review and network meta-analysis

2020 ◽  
Author(s):  
Yi Xu ◽  
Yimin Shen ◽  
Pengfei Zhao ◽  
Yuanyuan Han ◽  
Jun Jiang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Efficacy And Safety ◽  
Short Term ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Drug Eluting

Abstract Background: This network meta-analysis was committed to evaluating the efficacy and safety of different dual antiplatelet therapies (DAPTs) after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs).Methods: Randomized controlled trials (RCTs) comparing two of the following DAPT strategies: long-term (>12 months) DAPT (L-DAPT), 12-months DAPT (DAPT 12Mo), short-term (≤6 months) DAPT followed by aspirin monotherapy (S-DAPT+ASA), short-term DAPT followed by a P2Y12 receptor inhibitor monotherapy (S-DAPT+P2Y12) were searched. Primary outcomes were all-cause mortality, cardiac death, myocardial infarction (MI), stroke, major bleeding, any bleeding, definite or probable stent thrombosis (ST). This Bayesian network meta-analysis was performed with the random-effects model.Results: Twenty-four RCTs (n=81,376) were included. L-DAPT increased the risk of major bleeding (OR 2.37, 95%CI 1.32-5.03 compared with S-DAPT+P2Y12) and any bleeding (OR 2.95, 95%CI 1.91-4.34 compared with S-DAPT+P2Y12). When compared with L-DAPT, DAPT 12Mo (OR 1.54, 95%CI 1.13-2.02) and DAPT+ASA (OR 1.67, 95%CI 1.22-2.19) were associated with higher rates of MI, but S-DAPT+P2Y12 obtained no statistical difference. The sensitivity analysis revealed that the risks of major bleeding and any bleeding further increased for ≥18 months of DAPT. In the subgroup analysis, short-term DAPT (S-DAPT) presented similar efficacy and safety to DAPT 12Mo for patients with the acute coronary syndrome (ACS), and lower risks of major bleeding and all-cause mortality were observed in S-DAPT+P2Y12 among patients with newer-generation DES.Conclusions: S-DAPT+P2Y12 presented superiority in patients with all clinical presentations, for a lower risk of bleeding and not associated with increased ischemic harm. Besides, prospective research between aspirin monotherapy and P2Y12 monotherapy was required.

5193Percutaneous coronary intervention provided better result than optimal medical therapy in patients with chronic total occlusion: a metanalysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Khanra ◽  
B Duggal ◽  
I Basu Ray ◽  
B Kumar ◽  
R Walia
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
All Cause Mortality

Abstract Background Studies comparing the outcome of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) versus OMT alone in treatment of chronic total occlusion (CTO) are limited by observational design, variable follow up period, diverse clinical outcome, high drop-out and cross-over rate. Prematurely terminated DECISION CTO trail and the promising result of the most recent EUROCTO trial still left the quest unanswered. Previous metanalysis on the present context were restricted to studies with propensity-matched analysis only and did not incorporate the recent randomized trials. Purpose This study aims to conduct a meta-analysis of published data of observational as well as randomized studies comparing long term outcomes of PCI+OMT versus OMT alone. Methods The present protocol is registered in PROSPERO. PubMed, Embase and Cochrane databases were systematically reviewed. Fourteen studies meeting criteria were included in the meta-analysis. The Cochrane Risk of Bias scale was used to appraise the overall quality of the studies. Revman 5.3 software was used to analyse the data and random-effects model with inverse variance method was undertaken. R packages were used for assessment of bias and metaregression. Results Baseline parameters of both the groups were comparable. Major adverse cardiovascular events (MACE) which comprises of cardiac death, myocardial infarction, stroke, and unplanned revascularization [Figure 1] were significantly lower in the PCI+OMT group. (RR: 0.77; 95% CI: 0.61 to 0.97; P≤0.ehz746.00521; I2=85%). High heterogeneity was partially (14%) explained by age factor. However study design, follow up duration, LVEF, presence of TVD did not attribute significantly to heterogeneity, in isolation or any combination in metregression model. All cause mortality and cardiac death [Figure 2, 3 respectively] were significantly lower in the PCI+OMT group (P=0.29, p=0.63, respectively). Myocardial infarction (P=0.25) and stroke rates (P=0.15) were lower in the PCI+OMT group, however they did not reach statistical significance. Unplanned revascularization (of any vessel) showed a higher trend in the PCI+OMT group, without reaching statistical significance (P=0.46, I2=88%). Conclusion PCI of CTO is rewarded with better long term outcome, in terms of MACE and all-cause mortality but limited to greater unplanned revascularization. Acknowledgement/Funding None

scholarly journals Efficacy and Safety of EUS-Guided Choledochoduodenostomy Using Electrocautery-Enhanced Lumen-Apposing Metal Stents (ECE-LAMS) in the Treatment of Biliary Obstruction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zuxiang Peng ◽  
Shan Li ◽  
Yongliang Tang ◽  
Wanjie Wei ◽  
Ruxian Pi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Metal Stents ◽  
Efficacy And Safety ◽  
Short Term

Background. Electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) have been newly developed to perform EUS-guided choledochoduodenostomy (EUS-CDS), but its benefits and harms remain obscure. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-CDS using ECE-LAMS. Method. In the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched PubMed, Embase, and Scopus databases through January 1, 2001, and April 27, 2020. The primary outcomes of the pooled analysis were to determine the technical success, clinical success, and overall adverse events rates. The secondary outcomes were pooled rates of short-term and long-term adverse events. Results. Six studies with 270 patients were finally included in this meta-analysis. The pooled rates of technical, clinical success, and adverse events were 95.1% (95% CI = 90.6–97.5%, I2 = 25%), 93.3% (95% CI = 87.4–96.5%, I2 = 28%), and 15.3% (95% CI = 10.6–21.6%, I2 = 13%), respectively. The pooled rates of short-term and long-term adverse events were 3.6% (95% CI = 1.3–9.6%, I2 = 0%) and 11.3% (95% CI = 7.6–16.5%, I2 = 0%), respectively. Conclusion. EUS-CDS using ECE-LAMS provides favorable outcomes in patients with biliary obstruction. It has been associated with a higher success rate and a lower rate of adverse events when compared with the biliary drainage approaches previously used. Large and randomized controlled observational studies are required to further refine the findings in the present analysis.

scholarly journals Optimum of Dual Antiplatelet Duration and Followed Monotherapy in Diabetes Mellitus After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation: A Bayesian Network Meta-Analysis of 20536 Patients From 18 Randomized Trials

2021 ◽  
Author(s):  
Ke An ◽  
Peng Guo ◽  
Shanhu Qiu ◽  
Wenwen Zhu ◽  
Wuyou Cao ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Short Term ◽  
P2y12 Inhibitor ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Standard Term

Abstract Background: To evaluate the efficacy and safety of short-term (≤3-month) dual antiplatelet therapy (DAPT), midterm (6-month) DAPT, standard-term (12-month) DAPT and extended-term (＞12-month) DAPT in diabetes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). To Compare discontinuation of DAPT followed by aspirin with P2Y12 inhibitor monotherapy for detailed optimal scheme.Methods: Randomized, controlled trials were searched using PubMed, Web of Science, Embase, Cochrane library and clinicaltrials.gov. up to October 10, 2020. A Bayesian network meta-analysis was conducted with a random-effect model.Results: A total of 18 randomized trials encompassing 20536 diabetic patients were included. Network analysis showed that short-term DAPT is best for reducing primary endpoint, which is superior to extended-term DAPT (odds ratio 0.48, 95% CI 0.25 to 0.85). Standard-term was also associated with reduce risk of primary endpoint in comparison with prolonged DAPT (0.56, 0.32 to 0.90). There was no noticeable difference with respect to primary endpoint between short-term DAPT followed by aspirin monotherapy and P2Y12 inhibitor monotherapy. No significant differences were observed in secondary endpoints, including all-cause mortality, cardiac mortality, MI, stroke, TVR, definite or probable stent thrombosis and major bleeding.Conclusions: Short-term DAPT was associated with the better primary endpoint benefit for patients with diabetes after PCI with DES, compared with extended-term DAPT. Although the optimal duration should balance risk-benefit ratio between personal ischemic and bleeding events, this study suggested short term DAPT followed by P2Y12 inhibitor monotherapy may be the optimal therapy for most diabetes after PCI with DES.

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