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

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.

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Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: systematic review and meta-analysis of individual participant data from randomised trials

BMJ ◽

10.1136/bmj.i5483 ◽

2016 ◽

pp. i5483 ◽

Cited By ~ 27

Author(s):

Giuseppe Gargiulo ◽

Stephan Windecker ◽

Bruno R da Costa ◽

Fausto Feres ◽

Myeong-Ki Hong ◽

...

Keyword(s):

Systematic Review ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Drug Eluting Stent ◽

Individual Participant Data ◽

Randomised Trials ◽

Short Term ◽

Individual Participant ◽

Drug Eluting

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Abstract 18475: Is There Any End in Sight to This Debate on the Optimal Duration of Dual Antiplatelet Therapy After Drug-eluting Coronary Stent Implantation?

Circulation ◽

10.1161/circ.132.suppl_3.18475 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Olusegun Sheyin ◽

Xavier Perez ◽

Bredy Pierre-Louis ◽

Damian Kurian

Keyword(s):

Stent Thrombosis ◽

Major Bleeding ◽

Primary Outcome ◽

Dual Antiplatelet Therapy ◽

Cardiovascular Death ◽

Short Term ◽

Target Vessel Revascularization ◽

Significant Difference ◽

Drug Eluting

Introduction: There is no end in sight to the ongoing debate on the optimal duration of dual antiplatelet therapy (DAPT) following drug-eluting coronary stent (DES) implantation. Hypothesis: Short-term DAPT is less effective than long-term DAPT in preventing adverse cardiovascular and cerebrovascular outcomes following DES. Methods: MEDLINE, EMBASE, Scopus and CENTRAL were searched for eligible randomized controlled trials (RCTs) that compared short-term (≤ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary end point was a composite of all cause death, myocardial infarction, target vessel revascularization, stroke or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode. Results: A total of 15,378 patients from 7 RCTs were studied. There was no statistically significant difference between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome {Risk ratio (RR) 1.017 (0.872-1.186), I2 = 0%}, all cause death {RR 0.896 (0.708-1.134)}, cardiovascular death {RR 0.924 (0.668-1.279)}, myocardial infarction {RR 1.139 (0.887-1.461)}, target vessel revascularization {RR 1.174 (0.916-1.505)}, stent thrombosis {RR 1.264 (0.786-2.032)} and stroke {RR 0.876 (0.685-1.611)}. However there was a statistically significant lower risk of major bleeding in the short-term DAPT group {RR 0.57 (0.36-0.90), p 0.02}. There was no statistically significant difference in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, {RR 1.029 (0.745-1.421)} and {RR 1.062 (0.785-1.438)}, respectively. Conclusion: There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. Longer duration of DAPT was found to be associated with increased risk of major bleeding. These results are contrary to findings from the recently published DAPT trial. However, even though the DAPT trial reported a significant decrease in the incidence of stent thrombosis and major adverse cardiac and cerebrovascular events in the long-term DAPT group, there was a paradoxical increase in mortality.

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