Clinical Outcomes of Very Short Term Dual Antiplatelet Therapy in Patients With or Without Diabetes Undergoing Second-Generation Drug-Eluting Stents: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Autor: Xi-Ying Liang, Yan Li, Xuan Qiao, Wen-Jiao Zhang, Zhi-Lu Wang
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Frontiers in Cardiovascular Medicine, Vol 8 (2021)
Druh dokumentu: article
ISSN: 2297-055X
DOI: 10.3389/fcvm.2021.655718
Popis: Background: Patients with diabetes represent 20–30% of the population considered for percutaneous coronary intervention (PCI) and associate with more deleterious clinical outcome, which requires the optimal strategy of dual antiplatelet therapy (DAPT). The meta-analysis aims to compare clinical outcomes between very short (1–3 months) and standard (12 months) DAPT after implanting the second-generation drug-eluting stents in patients with or without diabetes following PCI.Methods and Analysis: PubMed, Embase, Web of Science, Ovid, Cochrane Library, and ClinicalTrials.gov were searched for studies comparing the very short term and standard DAPT in patients with or without diabetes following PCI. Risk ratio with 95% confidence intervals was used to evaluate the pooled effect of discontinuous variables, and the pooled analyses were performed with RevMan 5.3 and Stata SE 14.0 software.Results: A total of 38,864 patients were randomized to the very short term DAPT (N = 19,423) vs. standard DAPT (N = 19,441). Among them, 11,476 patients were diabetes and 27,388 patients were non-diabetes. The primary outcome of the net adverse clinical event (NACE) was significantly lower in diabetic patients with very short term DAPT (risk ratio 0.72, 95% CI 0.60–0.88, p = 0.0009). The same result was also found in the major cardiac or cerebrovascular events (MACCEs) (0.87, 0.78–0.98, p = 0.03). The risk of major or minor bleeding was significantly reduced in very short term DAPT regardless of the diabetes statue (0.69, 0.52–0.93, p = 0.01 in the diabetic group, and 0.50, 0.39–0.63, p
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