Drug Design, Development and Therapy (Jun 2018)
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
Hongqing Li, Wenqin Guo, Weiran Dai, Lang Li Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China 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 all-cause 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. Keywords: dual antiplatelet therapy, second-generation drug-eluting stent implantation, meta-analysis