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Comparative Efficacy and Safety of Duration of Dual Antiplatelet Therapy in Patients with CAD Undergoing Drug-eluting Stent Implantation: A Systematic Review and Network Meta-analysis

Author(s):

Jieqiong Guan, Wenjing Song, Pan He, Siyu Fan, Hong Zhi and Lina Wang*   Pages 1 - 6 ( 6 )

Abstract:


Objective: To evaluate the efficacy and safety of duration of dual antiplatelet therapy (DAPT) for patients who received percutaneous coronary intervention (PCI) with drug-eluting stent.

Background: The optimal duration of DAPT to balance the risk of ischemia and bleeding in CAD patients undergoing drugeluting stent (DES) implantation remains controversial.

Methods: PubMed, Cochrane Library, Web of Science, Clinicaltrials.gov, CNKI and Wanfang Databases were searched for randomized controlled trials of comparing different durations of DAPT after DES implantation. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), and major bleeding, and were pooled by Bayes network metaanalysis. Net adverse clinical and cerebral events was used to estimate the surface under the cumulative ranking (SUCRA) curves. The subgroup analysis based on clinical status, follow-up and area was conducted using traditional pairwise metaanalysis.

Results: A total of nineteen trials (n=51,035) were included, involving six duration strategies. The network meta-analysis showed that T2 (<6-month DAPT followed by aspirin, HR:1.51, 95%CI:1.02-2.22), T3 (standard 6-month DAPT, HR:1.47, 95%CI:1.14-1.91), T4 (standard 12-month DAPT, HR:1.41, 95%CI:1.15-1.75) and T5 (18-24 months DAPT, HR:1.47, 95%CI:1.09-1.97) was associated with significantly increased risk of MACCE compared to T6 (>24-month DAPT). However, no significant difference was found in MACCE risk between T1 (<6-month DAPT followed by P2Y12 monotherapy) and T6. Moreover, T5 was associated with significantly increased risk of bleeding compared to T1(RR:3.94, 95%CI:1.66-10.60), T2(RR:3.65, 95%CI:1.32-9.97), T3(RR:1.93, 95%CI:1.21-3.50) and T4(RR:1.89, 95%CI:1.15-3.30). The cumulative probabilities showed that T6(85.0%), T1(78.3%) and T4(44.5%) were the most efficacious treatment compared to the other durations. In the ACS (<50%) subgroup, T1 was significantly reduced the risk of major bleeding compared to T4, but not in the ACS (≥50%) subgroup.

Conclusions: Compared with other duration, short DAPT followed by P2Y12 inhibitor monotherapy showed noninferiority, with a lower risk of bleeding and not associated with an increased MACCE. In addition, the risk of major bleeding was increased significantly starting with DAPT for 18-month. Compared with the short-term treatment, patients with ACS with the standard 12-month treatment have the better prognosis, including lower bleeding rate and the deceased risk of MACCE. Due to studies limitations, the results should be verified in different risk populations.

Keywords:

Dual antiplatelet therapy, Duration, Drug-eluting stents, Network meta-analysis, Coronary artery disease

Affiliation:

Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, Department of Cardiology, ZhongDa Hospital, Southeast University, Nanjing, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing



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