Key result
Short-term (3-6 months) DAPT after PCI reduced major bleeding (RR 0.66; 95% CI 0.52-0.84) but increased repeat revascularization (RR 1.17; 95% CI 1.01-1.36) compared to 12-month DAPT.
Why the study?
There was a lack of wide-ranging safety and efficacy evaluation in both stable ischemic heart disease and ACS comparing short-term (3-6 months) versus standard-term (12 months) DAPT after PCI with DES.
Does short-term (3-6 months) dual antiplatelet therapy improve safety and efficacy outcomes compared to standard-term (12 months) therapy in patients with stable ischemic heart disease and acute coronary syndrome after PCI with DES?
Meta-Analysis (n=31,831)
Does short-term (3-6 months) dual antiplatelet therapy improve safety and efficacy outcomes compared to standard-term (12 months) therapy in patients with stable ischemic heart disease and acute coronary syndrome after PCI with DES?
Short-term DAPT (3-6 months) after PCI with DES reduces major bleeding but increases the risk of repeat revascularization compared to standard 12-month DAPT.
Answers are grounded in this paper and cite their sources.
Short-term DAPT may reduce bleeding after PCI at the expense of more revascularizations; challenges uniform 12-month recommendations with low-certainty evidence.
Newer generation drug eluting stents (DES) and pharmacotherapy have decreased thrombotic events post-percutaneous coronary intervention (PCI). There is lack of wide-ranging safety and efficacy evaluation in both stable ischemic heart disease and acute coronary syndrome in short-term (3-6 months) versus Standard-term (12 months) dual antiplatelet therapy (DAPT). We searched electronic databases using specific terms to identify randomized control trials comparing different durations of DAPT after PCI with DES. The outcomes of interest included all-cause mortality, myocardial infarction, stent thrombosis, major bleeding, target lesion and vessel revascularization, and stroke at follow-up duration ≥12 months post index PCI. Studies that compared DAPT <3 months or DAPT ≥12 months were excluded. Thirteen randomized control trials (n = 31,831) were included; 8401 patients received DAPT for 3 months and 7482 patients received DAPT in the 6 months group. Major bleeding rate was lower in the short-term (3-6 months) versus Standard-term (12 months) group (risk ratio 0.66; 95% confidence interval, 0.52-0.84, P < 0.05). Repeat revascularization rate was higher in the short-term (3-6 months) versus Standard-term (12 months) (risk ratio 1.17; 95% confidence interval, 1.01-1.36, P < 0.05) of DAPT duration after PCI with DES. No difference in other outcomes were observed when comparing short versus standard duration of DAPT in both stable ischemic heart disease and acute coronary syndrome.
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Bhattarai et al. (2020) conducted a meta-analysis in Stable ischemic heart disease and acute coronary syndrome (n=31,831). Short-term dual antiplatelet therapy (DAPT) vs. Standard-term (12 months) DAPT was evaluated on Major bleeding (RR 0.66, 95% CI 0.52-0.84, p=<0.05). Short-term (3-6 months) DAPT after PCI reduced major bleeding (RR 0.66; 95% CI 0.52-0.84) but increased repeat revascularization (RR 1.17; 95% CI 1.01-1.36) compared to 12-month DAPT.
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