Optimum of Dual Antiplatelet Duration and Followed Monotherapy in Diabetes Mellitus After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation: A Bayesian Network Meta-Analysis of 20536 Patients From 18 Randomized Trials

Background: To evaluate the efficacy and safety of short-term (≤3-month) dual antiplatelet therapy (DAPT), midterm (6-month) DAPT, standard-term (12-month) DAPT and extended-term (＞12-month) DAPT in diabetes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). To Compare discontinuation of DAPT followed by aspirin with P2Y12 inhibitor monotherapy for detailed optimal scheme. Methods: Randomized, controlled trials were searched using PubMed, Web of Science, Embase, Cochrane library and clinicaltrials.gov. up to October 10, 2020. A Bayesian network meta-analysis was conducted with a random-effect model. Results: A total of 18 randomized trials encompassing 20536 diabetic patients were included. Network analysis showed that short-term DAPT is best for reducing primary endpoint, which is superior to extended-term DAPT (odds ratio 0.48, 95% CI 0.25 to 0.85). Standard-term was also associated with reduce risk of primary endpoint in comparison with prolonged DAPT (0.56, 0.32 to 0.90). There was no noticeable difference with respect to primary endpoint between short-term DAPT followed by aspirin monotherapy and P2Y12 inhibitor monotherapy. No significant differences were observed in secondary endpoints, including all-cause mortality, cardiac mortality, MI, stroke, TVR, definite or probable stent thrombosis and major bleeding. Conclusions: Short-term DAPT was associated with the better primary endpoint benefit for patients with diabetes after PCI with DES, compared with extended-term DAPT. Although the optimal duration should balance risk-benefit ratio between personal ischemic and bleeding events, this study suggested short term DAPT followed by P2Y12 inhibitor monotherapy may be the optimal therapy for most diabetes after PCI with DES.