Key result
Short-term DAPT shows no difference versus long-term DAPT for primary outcomes in diabetic PCI patients.
Why the study?
Optimal DAPT duration after PCI remains uncertain, and studies evaluating optimal strategies after second-generation stents in patients with diabetes are limited despite their accelerated atherosclerosis.
Does short-term (3-6 months) DAPT improve outcomes compared to long-term (12 months) DAPT in diabetic patients undergoing PCI with second-generation drug-eluting stents?
Meta-Analysis (n=3,117)
Does short-term (3-6 months) DAPT improve outcomes compared to long-term (12 months) DAPT in diabetic patients undergoing PCI with second-generation drug-eluting stents?
Effect estimate: RR 0.96 (95% CI 0.68-1.35)
p-value: p=0.84
In diabetic patients receiving second-generation drug-eluting stents, short-term (3-6 months) DAPT appears to have similar efficacy and safety outcomes compared to long-term (12 months) DAPT.
May support shorter DAPT in diabetic PCI patients; extends evidence for comparable outcomes with 3-6 versus 12 months.
BACKGROUND: Duration of dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI) remains uncertain, with increasing data suggestive of acceptable short-term duration. Metabolically accelerated atherosclerosis associated with diabetes makes it essential to study short-term DAPT in this subgroup. With limited studies determining optimal DAPT strategies after second-generation stents in this subset, we aimed to establish the optimal duration of DAPT in the diabetic population using second-generation stents. QUESTION: To determine optimal DAPT duration in diabetic population undergoing PCI in 2nd generation stents. DATA SOURCES: We conducted an electronic database search of randomized controlled trials from PubMed/Medline, Embase, Cochrane, and Web of Science databases. STUDY DESIGN: A meta-analysis was conducted comparing outcomes of short-term (3-6 months) DAPT therapy versus long-term (12 months) DAPT therapy in the diabetic population undergoing PCI with second-generation stents. RESULTS: A total of 5 randomized controlled trials were included with a total of 3117 diabetic patients. Short-term DAPT did not show any statistical difference from long-term DAPT in achieving primary outcomes (relative ratio: 0.96, 95% confidence interval (CI) 0.68-1.35, P = 0.84). Overall mortality (OR 0.92; 95% CI, 0.52-1.63, P = 0.98), myocardial infarction [odds ratio (OR)OR 1.02; 95% CI, 0.53-1.94, P = 0.85], stent thrombosis (OR 1.20; 95% CI, 0.55-2.60, P = 0.55), target vessel revascularization (OR 1.10; 95% CI, 0.45-2.73, P = 0.74), and stroke (OR 0.50; 95% CI, 0.082-2.43, P = 0.81) did not show any statistical difference between the 2 groups. Similarly, a subgroup analysis of study population comparing 6 versus 12 months of DAPT in diabetic population did not show any difference in net primary outcomes (relative ratio: 0.86, 95% CI 0.45-1.45, P = 0.60). There was no significant heterogeneity noted between the 2 groups. CONCLUSION: This meta-analysis showed no statistically significant benefit of longer DAPT over shorter DAPT therapy in patients undergoing PCI with drug-eluting stent in patients with diabetes.
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Gangwani et al. (2022) conducted a meta-analysis in Diabetes undergoing PCI with second-generation stents (n=3,117). Short-term DAPT vs. Long-term DAPT was evaluated on primary outcomes (RR 0.96, 95% CI 0.68-1.35, p=0.84). Short-term DAPT (3-6 months) showed no statistical difference compared to long-term DAPT (12 months) for primary outcomes in diabetic patients undergoing PCI (RR 0.96; 95% CI 0.68-1.35; P=0.84).
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