Key result
Short-term DAPT (≤6 months) showed no significant difference compared to long-term DAPT (≥12 months) for late stent thrombosis (OR 1.15; 95% CI 0.42-3.19; P=0.79) in patients with diabetes.
Why the study?
Diabetes is a high-risk factor for thromboembolic events, but available data regarding the optimal DAPT duration in DM patients after second-generation DES implantation are scant.
Does short-term DAPT (≤ 6 months) compared to long-term DAPT (≥ 12 months) improve or maintain clinical outcomes in patients with diabetes mellitus after second-generation DES implantation?
Meta-Analysis (n=3,657)
Does short-term DAPT (≤ 6 months) compared to long-term DAPT (≥ 12 months) improve or maintain clinical outcomes in patients with diabetes mellitus after second-generation DES implantation?
Odds Ratio: 1.15 (95% CI 0.42–3.19)
p-value: p=0.79
Short-term DAPT (≤ 6 months) appears to be as safe and effective as long-term DAPT (≥ 12 months) for patients with diabetes mellitus receiving second-generation drug-eluting stents.
Supports shorter DAPT in diabetics after second-generation DES; confirms no excess late stent thrombosis risk versus prolonged therapy.
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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Zhang et al. (2020) conducted a meta-analysis in Diabetes mellitus after second-generation drug-eluting stent implantation (n=3,657). Short-term dual antiplatelet therapy (≤ 6 months) vs. Long-term dual antiplatelet therapy (≥ 12 months) was evaluated on Late (31-365 days) stent thrombosis (OR 1.15, 95% CI 0.42-3.19, p=0.79). Short-term DAPT (≤6 months) showed no significant difference compared to long-term DAPT (≥12 months) for late stent thrombosis (OR 1.15; 95% CI 0.42-3.19; P=0.79) in patients with diabetes.
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