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Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials

Authors Li H, Guo W, Dai W, Li L

Received 13 February 2018

Accepted for publication 17 April 2018

Published 22 June 2018 Volume 2018:12 Pages 1815—1825


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Anastasios Lymperopoulos

Hongqing Li, Wenqin Guo, Weiran Dai, Lang Li

Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi, China

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 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.

Keywords: dual antiplatelet therapy, second-generation drug-eluting stent implantation, meta-analysis

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