Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials
| Autor: | Robert A. Byrne, Davide Capodanno, Yuji Matsuda, Giuseppe Gargiulo, Roxana Mehran, Giuseppe Tarantini, Daniele Giacoppo, Luca Nai Fovino, Marco Valgimigli, Gianpiero D'Amico |
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| Přispěvatelé: | University of Zurich |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Ticagrelor
medicine.medical_specialty medicine.medical_treatment 610 Medicine & health 030204 cardiovascular system & hematology 11171 Cardiocentro Ticino law.invention 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Randomized controlled trial law Internal medicine Medicine Humans 030212 general & internal medicine Stroke Randomized Controlled Trials as Topic Aspirin business.industry Surrogate endpoint Antiplatelet therapy Stent Percutaneous coronary intervention Drug-Eluting Stents medicine.disease Meta-analysis Drug-eluting stent Treatment Outcome Cardiology Purinergic P2Y Receptor Antagonists Drug Therapy Combination Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Popis: | Aims After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear. Methods and results Multiple electronic databases, including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were searched to identify randomized clinical trials comparing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with second-generation DES implantation. The primary and co-primary outcomes of interest were major bleeding and stent thrombosis 1 year after randomization. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fixed-effect and random-effects models. Multiple sensitivity analyses including random-effects models 95% CI adjustment were applied. A sensitivity analysis comparing trials using P2Y12 inhibitor SAPT with those using aspirin SAPT was performed. A total of five randomized clinical trials (32 145 patients) were available. Major bleeding was significantly lower in the patients assigned to short DAPT followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month DAPT (random-effects model: HR 0.63, 95% 0.45–0.86). No significant differences between groups were observed in terms of stent thrombosis (random-effects model: HR 1.19, 95% CI 0.86–1.65) and the secondary endpoints of all-cause death (random-effects model: HR 0.85, 95% CI 0.70–1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI 0.89–1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68–1.74). Sensitivity analyses showed overall consistent results. By comparing trials testing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT with trials testing ≤3 months of DAPT followed by aspirin SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction for each endpoint. By combining all these trials, regardless of the type of SAPT, short DAPT was associated with lower major bleeding (random-effects model: HR 0.63, 95% CI 0.48–0.83) and no differences in stent thrombosis, all-cause death, myocardial infarction, and stroke were observed between regimens. Conclusion After second-generation DES implantation, 1–3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation. |
| Databáze: | OpenAIRE |
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