Key result
Prolonged DAPT (12-36 months) after newer generation DES implantation in diabetic patients did not reduce major adverse cardiac events compared to shorter courses (OR 1.00; 95% CrI 0.74-1.33).
Why the study?
Does prolonged dual antiplatelet therapy (12-36 months) reduce major adverse cardiac events compared to shorter courses (3-12 months) in diabetic patients after newer generation drug-eluting stent implantation?
Meta-Analysis (n=8,542)
Does prolonged dual antiplatelet therapy (12-36 months) reduce major adverse cardiac events compared to shorter courses (3-12 months) in diabetic patients after newer generation drug-eluting stent implantation?
Effect estimate: OR 1.00 (95% CI 0.74-1.33)
Prolonged DAPT (12-36 months) does not improve outcomes compared to shorter DAPT (3-12 months) in diabetic patients after newer generation DES implantation, supporting adherence to general population guidelines.
No MACE benefit with prolonged DAPT in diabetics after newer DES; leaves open optimal duration versus general guidelines.
PURPOSE OF REVIEW: To analyze evidence from randomized clinical trials (RCTs) that identifies the optimal duration of dual antiplatelet therapy (DAPT) after implantation of newer generation drug-eluting stents (DESs) in diabetic patients. RECENT FINDINGS: Patients with diabetes mellitus have increased risk of ischemic events and bleeding after DES implantation. The optimal duration of DAPT for this population is currently unknown. In a subgroup analysis of 8542 diabetic patients enrolled in eight RCTs of DAPT duration after implantation of newer generation DESs, prolonged courses of DAPT of 12-36 months in duration resulted in rates of major adverse cardiac events that were no different from those seen after shorter courses of DAPT of 3-12 months in duration (odds ratio 1.00, 95% Bayesian credible interval 0.74-1.33). SUMMARY: Prolonged DAPT up to 36 months after newer generation DES implantation in diabetic subgroups has not been associated with better outcomes than shorter courses of 3-12 months. Until dedicated trials are completed in diabetic populations, DAPT duration after newer generation DES implantation in patients with diabetes mellitus should follow recommendations for the general population.
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John A. Bittl (2016) conducted a meta-analysis in Diabetes mellitus after implantation of newer generation drug-eluting stents (n=8,542). Prolonged dual antiplatelet therapy vs. Shorter courses of dual antiplatelet therapy was evaluated on Major adverse cardiac events (OR 1.00, 95% CI 0.74-1.33). Prolonged DAPT (12-36 months) after newer generation DES implantation in diabetic patients did not reduce major adverse cardiac events compared to shorter courses (OR 1.00; 95% CrI 0.74-1.33).
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