Key result
Short-term DAPT compared to long-term DAPT increased the primary outcome in non-East Asians (OR 1.16; 95% CI 1.02-1.32; p=0.02), but had comparable effects in East Asians.
Why the study?
While dual antiplatelet therapy is essential after PCI, the effect of ethnicity on optimal DAPT duration has not been fully evaluated.
Does short-term DAPT compared to long-term DAPT have different efficacy and safety outcomes in East Asian versus non-East Asian patients after PCI?
Meta-Analysis (n=38,255)
Yes
Does short-term DAPT compared to long-term DAPT have different efficacy and safety outcomes in East Asian versus non-East Asian patients after PCI?
Odds Ratio: 1.16 (95% CI 1.02–1.32)
p-value: p=0.02
Short-term DAPT may be adequate for East Asian patients after PCI, whereas non-East Asian patients may benefit from long-term DAPT to reduce ischemic events.
Short-term DAPT may suffice for East Asians after PCI but not non-East Asians; extends evidence for ethnicity-tailored strategies.
While dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention (PCI), the optimal duration is affected by various factors. However, the effect of ethnicity on DAPT duration has not been fully evaluated. In this study, we evaluated the different effect of DAPT duration by ethnicity. We searched Pubmed, Embase, Cochrane library, and relevant websites to search for randomized clinical trials (RCT) assessing the clinical impact of long term DAPT (L-DAPT) and short term DAPT (S-DAPT). Studies were divided by ethnicity, and we compared the efficacy and safety of DAPT duration in each ethnic group. Thirteen RCTs including 38,255 patients (five East Asian studies and eight non–East Asian studies) were eligible for analysis. For the primary outcome, L-DAPT showed a significantly lower rate of primary outcome only in non–East Asians (S-DAPT vs. L-DAPT, odds ratio (OR) = 1.16, 95% confidence interval (CI): 1.02–1.32, p = 0.02), while in East Asians, the effect of S-DAPT and L-DAPT were comparable. S-DAPT significantly increased ischemic events only in non–East Asians (S-DAPT vs. L-DAPT, OR = 1.24, 95% CI: 1.09–1.42, p <0.01), while bleeding events were decreased by S-DAPT in both ethnicities. These results demonstrate that the adequate DAPT duration after PCI may be different in East Asians.
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Ki et al. (2020) conducted a meta-analysis in Post-percutaneous coronary intervention (PCI) (n=38,255). Short-term dual antiplatelet therapy (S-DAPT) vs. Long-term dual antiplatelet therapy (L-DAPT) was evaluated on primary outcome (OR 1.16, 95% CI 1.02-1.32, p=0.02). Short-term DAPT compared to long-term DAPT increased the primary outcome in non-East Asians (OR 1.16; 95% CI 1.02-1.32; p=0.02), but had comparable effects in East Asians.
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