Shorter (≤6 months) vs. longer (≥12 months) dual antiplatelet therapy after second-generation drug-eluting stents implantation: a meta-analysis of randomized controlled trials

Optimal duration of dual antiplatelet therapy (DAPT) after second-generation drug-eluting stent (DES) remains unknown. We performed a meta-analysis to evaluate the efficacy and safety of ≤6-month vs. ≥12-month DAPT after implantation of second-generation DES in order to estimate the optimal duration of DAPT. We conducted a literature search for randomized control trials (RCTs) in popular databases including EMBASE, PubMed, the Cochrane Library, and Scopus. Independent investigators abstracted the data on outcomes, characteristics, and qualities of trials included. A fixed-effect model was adopted to pool odds ratios with 95% confidence intervals of the clinical outcomes concerned when I2< 25% or P > 0.05, a random-effect model was applied in other cases. Five published RCTs involving 8407 patients were included in our analysis. There was no significant difference in definite or probable stent thrombosis, myocardial infarction, stroke, target vessel revascularization, all-cause death, and cardiac death between the shorter duration and the longer duration of DAPT. Moreover, no significant difference was observed in the incidences of major bleeding and any bleeding. None of the clinical outcomes differed in patients receiving everolimus-eluting stent or zotarolimus-eluting stent across DAPT groups. Shorter DAPT (≤6 months) after the second-generation DES implantation has no increased risks of adverse cardiac and cerebral events compared with longer DAPT (≥12 months). In addition, longer DAPT does not increase bleeding complications when compared with shorter duration.