Key result
Short-term dual antiplatelet therapy (≤3 months) significantly reduced the primary endpoint compared to extended-term therapy (>12 months) in diabetic patients after PCI with DES implantation (OR 0.48).
Why the study?
Standard 12-month DAPT after PCI with DES recommended for the general population may not be suitable for patients with diabetes.
Does short-term dual antiplatelet therapy reduce the primary composite endpoint compared to extended-term therapy in diabetic patients after percutaneous coronary intervention with drug-eluting stent implantation?
Meta-Analysis (n=20,536)
Does short-term dual antiplatelet therapy reduce the primary composite endpoint compared to extended-term therapy in diabetic patients after percutaneous coronary intervention with drug-eluting stent implantation?
Odds Ratio: 0.48 (95% CI 0.25–0.85)
p-value: p=<0.05
Short-term DAPT (≤3 months) followed by monotherapy is associated with a reduced primary composite endpoint compared to extended-term DAPT (>12 months) in diabetic patients after PCI with DES.
Supports short-term DAPT in diabetic patients after DES-PCI; extends network evidence favoring abbreviated over extended regimens.
INTRODUCTION: The standard 12-month dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation that is recommended for the general population may not be suitable for patients with diabetes. OBJECTIVES: The study aimed to evaluate the efficacy and safety of short-term (≤3 months), medium-term (6 months), standard-term (12 months), and extended-term (>12 months) DAPT in diabetic patients with DES implantation and to compare the outcomes of DAPT discontinuation followed by monotherapy with aspirin versus a P2Y12 receptor inhibitor. PATIENTS AND METHODS: Randomized controlled trials published up to October 10, 2020 were searched in the PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov databases. A Bayesian network meta-analysis with a random-effects model was performed. A total of 18 randomized trials involving 20 536 patients with diabetes were included. RESULTS: The network analysis showed that short-term DAPT was the most optimal in terms of reducing the primary endpoint and was superior to extended-term DAPT (odds ratio [OR], 0.48; 95% CI, 0.25–0.85). Standard-term DAPT was also associated with a reduced primary endpoint in comparison with extended-term DAPT (OR, 0.56; 95% CI, 0.32–0.90). There was no noticeable difference with respect to the primary endpoint between short-term DAPT followed by monotherapy with aspirin and a P2Y12 inhibitor. No significant differences were observed in secondary endpoints, including all-cause mortality, cardiac mortality, myocardial infarction, stroke, target vessel revascularization, definite or probable stent thrombosis, and major bleeding event. CONCLUSIONS: Short-term DAPT, as compared with extended-term therapy, was associated with a reduced primary endpoint in patients with diabetes after PCI with DES implantation.
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An et al. (2021) conducted a meta-analysis in Diabetes mellitus after percutaneous coronary intervention with drug-eluting stent implantation (n=20,536). Short-term dual antiplatelet therapy (≤3 months) vs. Extended-term dual antiplatelet therapy (>12 months) was evaluated on Primary endpoint (composite as defined in each trial) (OR 0.48, 95% CI 0.25-0.85, p=<0.05). Short-term dual antiplatelet therapy (≤3 months) significantly reduced the primary endpoint compared to extended-term therapy (>12 months) in diabetic patients after PCI with DES implantation (OR 0.48).
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