Key result
Short-term DAPT matches long-term DAPT for all-cause mortality after second-generation DES implantation.
Why the study?
The optimal duration of dual antiplatelet therapy after second-generation drug-eluting stent implantation remains unclear.
Does short-term DAPT (≤6 months) compared to long-term DAPT (≥12 months) improve clinical and safety outcomes in patients implanted with second-generation DES?
Meta-Analysis (n=13,571)
Does short-term DAPT (≤6 months) compared to long-term DAPT (≥12 months) improve clinical and safety outcomes in patients implanted with second-generation DES?
Hazard Ratio: 0.91 (95% CI 0.71–1.17)
Short-term DAPT (≤6 months) is not inferior to long-term DAPT (≥12 months) for ischemic and bleeding outcomes in patients receiving second-generation DES.
Supports shorter DAPT after second-generation DES to limit bleeding; confirms mortality noninferiority versus prolonged regimens.
BACKGROUND: The optimal dual antiplatelet therapy (DAPT) duration after second-generation drug-eluting stent (DES) implantation remains unclear. We aim to evaluate the efficacy and safety of short-term (≤6 months) and long-term (≥12 months) DAPT after second-generation DES implantation. METHODS: Randomized controlled trials (RCTs) were searched in PubMed, the Cochrane Library, the Embase and ClinicalTrials.gov in the English language. The endpoints included all-cause mortality, cardiac death, non-cardiac death, myocardial infarction (MI), stent thrombosis (ST), stroke, all bleeding, and major bleeding. The effect estimate was expressed by using the hazard ratio (HR) with 95% CI and random effect models. RESULTS: Seven RCTs with 13,571 patients were included in this study. In terms of survival endpoints, there was no significant difference in all-cause mortality (HR: 0.91; 95% CI: 0.71-1.17), cardiac death (HR: 0.93; 95% CI: 0.67-1.29), and non-cardiac death (HR: 0.89; 95% CI: 0.62-1.28) in the 2 groups. Moreover, there was no significant difference in ischemic outcomes, including MI (HR: 1.15; 95% CI: 0.91-1.45), ST (HR: 1.11; 95% CI: 0.75-1.66), and stroke (HR: 0.85; 95% CI: 0.53-1.35) in the 2 groups. In terms of bleeding endpoints, there was no significant difference in all bleeding (HR: 0.81; 95% CI: 0.64-1.04) and major bleeding (HR: 0.82; 95% CI: 0.49-1.36) in the 2 groups. The subgroup analysis showed that the proportion of patients with acute coronary syndrome was not associated with the benefit of long-term versus short-term DAPT. CONCLUSION: Short-term DAPT is not inferior to long-term DAPT in patients implanted with second-generation DES.
No takes yet. Share an insight, caveat, or question.
Li et al. (2018) conducted a meta-analysis in Second-generation drug-eluting stent implantation (n=13,571). Short-term dual antiplatelet therapy (≤6 months) vs. Long-term dual antiplatelet therapy (≥12 months) was evaluated on All-cause mortality (HR 0.91, 95% CI 0.71-1.17). Short-term DAPT (≤6 months) was not inferior to long-term DAPT (≥12 months) for all-cause mortality (HR 0.91; 95% CI 0.71-1.17) after second-generation DES implantation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: