Key result
DAPT de-escalation significantly reduced the risk of net adverse clinical events compared with potent P2Y12 inhibitor monotherapy (OR 0.72) in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
Why the study?
Balancing the effects of different antiplatelet strategies, including DAPT de-escalation, potent P2Y12 inhibitor monotherapy, and conventional DAPT after ACS, remains an open clinical question.
Does DAPT de-escalation reduce net adverse clinical events compared to potent P2Y12 inhibitor monotherapy or conventional DAPT in ACS patients undergoing PCI with DES?
Meta-Analysis (n=63,982)
Does DAPT de-escalation reduce net adverse clinical events compared to potent P2Y12 inhibitor monotherapy or conventional DAPT in ACS patients undergoing PCI with DES?
Odds Ratio: 0.72 (95% CI 0.55–0.96)
In a network meta-analysis of ACS patients undergoing PCI, DAPT de-escalation reduced net adverse clinical events compared to potent P2Y12 inhibitor monotherapy and conventional DAPT.
May favor DAPT de-escalation over potent P2Y12 monotherapy in ACS PCI; extends network evidence for tailored regimens.
Background: Dual antiplatelet therapy (DAPT) with potent P2Y12 inhibitor is the cornerstone of acute coronary syndrome (ACS) management. Balancing the effects of different strategies of antiplatelet therapy including DAPT de-escalation, potent P2Y12 inhibitor monotherapy, and conventional DAPT is a hot topic. Methods: A systematic search was conducted from the MEDLINE, PubMed, and Embase through October 2021 to identify various DAPT strategies in randomized controlled trials (RCTs) for treatment of ACS patients after undergoing PCI with drug-eluting stent (DES). The network meta-analysis was performed to investigate the net clinic benefit of the DAPT de-escalation, potent P2Y12 inhibitor monotherapy, as well as conventional DAPT. The primary outcome was net adverse clinical events, defined as a composite of major bleeding and cardiac death, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization. The secondary outcomes include major adverse cardiac events and trial-defined major or minor bleeding. Results: A total of 14 RCTs with 63,982 patients were included. The DAPT de-escalation was associated with a lower risk of the primary outcome compared with potent P2Y12 inhibitor monotherapy (De-escalation vs monotherapy odds ratio (OR): 0.72 95% confidence interval (CI): 0.55-0.96), and other antiplatelet strategies (De-escalation vs clopidogrel + aspirin OR: 0.49 95% CI: 0.39-0.63; De-escalation vs prasugrel + aspirin OR: 0.76 95% CI: 0.59-0.98; De-escalation vs ticagrelor + aspirin OR: 0.76 95% CI: 0.55-0.90). There were no statistical differences in the incidence of bleeding (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.73 95% CI: 0.47-1.12) and major adverse cardiac events (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.79 95% CI: 0.59-1.08) between DAPT de-escalation and potent P2Y12 inhibitor monotherapy. Conclusions: This network meta-analysis showed that DAPT de-escalation would reduce the net adverse clinical events, compared with potent P2Y12 inhibitor monotherapy, for ACS patients undergone PCI treatment.
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Ding et al. (2022) conducted a meta-analysis in Acute Coronary Syndrome (ACS) post-Percutaneous Coronary Intervention (PCI) (n=63,982). DAPT de-escalation vs. Potent P2Y12 inhibitor monotherapy was evaluated on Net adverse clinical events (composite of major bleeding and cardiac death, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization) (OR 0.72, 95% CI 0.55-0.96). DAPT de-escalation significantly reduced the risk of net adverse clinical events compared with potent P2Y12 inhibitor monotherapy (OR 0.72) in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
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