Comparison of clinical outcomes with short-term and long-term DAPT after PCI using second-generation drug-eluting stents in high bleeding risk patient : a systematic review and meta-analysis

Background Now that second-generation drug-eluting stents (DES) are available in almost every hospital in the world, it is unknown whether reducing the duration of double antiplatelet therapy (DAPT) following percutaneous coronary intervention in high-bleeding-risk (HBR) populations is beneficial and safe. Purpose This systematic review and meta-analysis aims to determine the safety, efficacy, and advantages of shortening the duration of DAPT (<6 months) in HBR patients with second-generation DES implantation. Methods We searched Ebsco, PubMed, Web of Science, Scopus, and Google scholar databases from inception to December 2022 for papers comparing short-term DAPT (6 months) followed by aspirin or P2Y 12 inhibitor monotherapy with long-term DAPT (6 months) in HBR patients after PCI with second generation DES. The primary objectives are major bleeding, definite or probable stent thrombosis (ST), and myocardial infarction (MI), while the secondary endpoint is mortality from any cause. Random-effect models were used to assess the relative risk and 95% confidence interval. Results This study included 9,789 HBR patients from three observational studies and one randomized controlled trial (Figure 1). Short DAPT for HBR patients undergoing PCI with second generation DES had a tendency of lower incidence of major bleeding in comparison with standard (6 months) DAPT, even though statistically non-significant (2.33% vs. 3.36%, RR 0.66 [95% CI 0.39 – 1.10], p = 0.11). Short-term DAPT was also found to be comparable and non-inferior to standard DAPT with in term of stent thrombosis (0.251% vs. 0.252%, RR 1.00 [95% CI 0.46-2.17], p = 0.99), Myocardial Infarction (2.08% vs. 1.85%, RR 1.09 [95% CI 0.82-1.44], p = 0.57), and All cause of death (3.01% vs. 2.56%, RR 1.17 [95% CI 0.93-1.49], p = 0.18) (Figure 2). Conclusions Among HBR patients implanted with second-generation DES, short DAPT was associated with slightly lower but comparable risk of major bleeding and non-inferior to reduce stent thrombosis, myocardial infarction, and all cause of death compared to standard DAPT.