Short-term DAPT (≤6 months) after DES implantation showed similar MACE rates compared to long-term DAPT (≥1 year) in both women (HR 0.88) and men (HR 1.25; P-interaction=0.08).
Meta-Analysis (n=11,473)
Yes
Does short-term (≤6 months) dual antiplatelet therapy reduce major adverse cardiac events and bleeding compared to long-term (≥1 year) therapy in women versus men after drug-eluting stent placement?
Short-term DAPT (≤6 months) after DES implantation is associated with similar MACE rates but lower bleeding risk compared to prolonged DAPT (≥1 year), with no significant sex differences.
Effect estimate: HR 0.88 (women); HR 1.25 (men) (95% CI 0.62-1.25 (women); 0.95-1.6 (men))
p-value: p=0.08 (interaction)
BACKGROUND: Whether the efficacy and safety of dual antiplatelet therapy (DAPT) are uniform between sexes is unclear. We sought to compare clinical outcomes between short- (≤6 months) versus long-term (≥1 year) DAPT after drug-eluting stent (DES) placement in women and men. METHODS AND RESULTS: We pooled individual patient data from 6 randomized trials of DAPT (EXCELLENT, OPTIMIZE, PRODIGY, RESET, SECURITY, ITALIC PLUS). The primary outcome was 1-year risk of major adverse cardiac events (MACE). The main secondary outcome was 1-year risk of any bleeding. Out of the 11,473 randomized patients included in the pooled dataset, 3,454 (30%) were females. At 1-year follow-up, women had higher risk of MACE (3.6% vs. 2.8%; P = 0.01) but similar risk of bleeding (1.9% vs. 1.6%; P = 0.16) as compared with men. Compared with long-term DAPT, short-term DAPT was associated with similar rates of MACE in both women (HR 0.88; 95% CI 0.62-1.25) and men (HR 1.25; 95% CI 0.95-1.6; P interaction = 0.08)]. At 1-year follow-up, short-term DAPT was associated with lower rates of bleeding as compared with long-term DAPT in both women (HR 0.84; 95% CI 0.51-1.37) and men (HR 0.58; 95% CI 0.40-0.84; P-interaction = 0.25). The presence of MVD was associated with higher MACE rates in the short-term DAPT group in women (HR: 1.16; CI 0.60-2.23) and men (HR: 2.29; CI 1.22-4.29; P interaction = 0.25). CONCLUSIONS: Short-term DAPT is associated with similar rates of MACE but lower risk of bleeding when as compared with prolonged DAPT. There was no significant difference between sexes in the population studied. © 2016 Wiley Periodicals, Inc.
Sawaya et al. (Mon,) conducted a meta-analysis in Drug-eluting stent (DES) placement (n=11,473). Short-term DAPT (≤6 months) vs. Long-term DAPT (≥1 year) was evaluated on 1-year risk of major adverse cardiac events (MACE) (HR 0.88 (women); HR 1.25 (men), 95% CI 0.62-1.25 (women); 0.95-1.6 (men), p=0.08 (interaction)). Short-term DAPT (≤6 months) after DES implantation showed similar MACE rates compared to long-term DAPT (≥1 year) in both women (HR 0.88) and men (HR 1.25; P-interaction=0.08).
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