Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: Systematic review and meta-analysis of individual participant data from randomised trials

Giuseppe Gargiulo, Stephan Windecker, Bruno R Da Costa, Fausto Feres, Myeong Ki Hong, Martine Gilard, K. ImHyo-Soo, Antonio Colombo, Deepak L. Bhatt, Byeong Keuk Kim, Marie Claude Morice, Kyung Woo Park, Alaide Chieffo, Tullio Palmerini, Gregg W. Stone, Marco Valgimigli

Research output: Contribution to journalReview article

24 Citations (Scopus)

Abstract

Objective: To compare clinical outcomes between short term (up to 6 months) and long term (12 months) dual antiplatelet therapy (DAPT) after placement of a drug eluting stent in patients with and without diabetes. Design: Individual participant data meta-analysis. Cox proportional regression models stratified by trial were used to assess the impact of diabetes on outcomes. Data source: Medline, Embase, and Cochrane databases and proceedings of international meetings searched for randomised controlled trials comparing durations of DAPT after placement of a drug eluting stent. Individual patient data pooled from six DAPT trials. Primary outco me: Primary study outcome was one year risk of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, or definite/probable stent thrombosis. All analyses were conducted by intention to treat. Results: Six trials including 11 473 randomised patients were pooled. Of these patients, 3681 (32.1%) had diabetes and 7708 (67.2%) did not (mean age 63.7 (SD 9.9) and 62.8 (SD 10.1), respectively), and in 84 (0.7%) the information was missing. Diabetes was an independent predictor of MACE (hazard ratio 2.30, 95% confidence interval 1.01 to 5.27; P=0.048 At one year follow-up, long term DAPT was not associated with a decreased risk of MACE compared with short term DAPT in patients with (1.05, 0.62 to 1.76; P=0.86) or without (0.97, 0.67 to 1.39; P=0.85) diabetes (P=0.33 for interaction). The risk of myocardial infarction did not differ between the two DAPT regimens (0.95, 0.58 to 1.54; P=0.82; for those with diabetes and 1.15, 0.68 to 1.94; P=0.60; for those without diabetes (P=0.84 for interaction). There was a lower risk of definite/ probable stent thrombosis with long term DAPT among patients with (0.26, 0.09 to 0.80; P=0.02) than without (1.42, 0.68 to 2.98; P=0.35) diabetes, with positive interaction testing (P=0.04 for interaction), although the landmark analysis showed a trend towards benefit in both groups. Long term DAPT was associated with higher rates of major or minor bleeding, irrespective of diabetes (P=0.37 for interaction). Conclusions: Although the presence of diabetes emerged as an independent predictor of MACE after implantation of a drug eluting stent, compared with short term DAPT, long term DAPT did not reduce the risk of MACE but increased the risk of bleeding among patients with stents with and without diabetes.

Original languageEnglish
Article numberi5483
JournalBMJ (Online)
Volume355
DOIs
Publication statusPublished - 2016 Jan 1

Fingerprint

Drug-Eluting Stents
Meta-Analysis
Stents
Therapeutics
Thrombosis
Myocardial Infarction
Hemorrhage
Information Storage and Retrieval
Randomized Controlled Trials
Outcome Assessment (Health Care)
Databases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Gargiulo, Giuseppe ; Windecker, Stephan ; R Da Costa, Bruno ; Feres, Fausto ; Hong, Myeong Ki ; Gilard, Martine ; ImHyo-Soo, K. ; Colombo, Antonio ; Bhatt, Deepak L. ; Kim, Byeong Keuk ; Morice, Marie Claude ; Park, Kyung Woo ; Chieffo, Alaide ; Palmerini, Tullio ; Stone, Gregg W. ; Valgimigli, Marco. / Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes : Systematic review and meta-analysis of individual participant data from randomised trials. In: BMJ (Online). 2016 ; Vol. 355.
@article{a6ac35680db443728d296fc25aefd6f0,
title = "Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: Systematic review and meta-analysis of individual participant data from randomised trials",
abstract = "Objective: To compare clinical outcomes between short term (up to 6 months) and long term (12 months) dual antiplatelet therapy (DAPT) after placement of a drug eluting stent in patients with and without diabetes. Design: Individual participant data meta-analysis. Cox proportional regression models stratified by trial were used to assess the impact of diabetes on outcomes. Data source: Medline, Embase, and Cochrane databases and proceedings of international meetings searched for randomised controlled trials comparing durations of DAPT after placement of a drug eluting stent. Individual patient data pooled from six DAPT trials. Primary outco me: Primary study outcome was one year risk of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, or definite/probable stent thrombosis. All analyses were conducted by intention to treat. Results: Six trials including 11 473 randomised patients were pooled. Of these patients, 3681 (32.1{\%}) had diabetes and 7708 (67.2{\%}) did not (mean age 63.7 (SD 9.9) and 62.8 (SD 10.1), respectively), and in 84 (0.7{\%}) the information was missing. Diabetes was an independent predictor of MACE (hazard ratio 2.30, 95{\%} confidence interval 1.01 to 5.27; P=0.048 At one year follow-up, long term DAPT was not associated with a decreased risk of MACE compared with short term DAPT in patients with (1.05, 0.62 to 1.76; P=0.86) or without (0.97, 0.67 to 1.39; P=0.85) diabetes (P=0.33 for interaction). The risk of myocardial infarction did not differ between the two DAPT regimens (0.95, 0.58 to 1.54; P=0.82; for those with diabetes and 1.15, 0.68 to 1.94; P=0.60; for those without diabetes (P=0.84 for interaction). There was a lower risk of definite/ probable stent thrombosis with long term DAPT among patients with (0.26, 0.09 to 0.80; P=0.02) than without (1.42, 0.68 to 2.98; P=0.35) diabetes, with positive interaction testing (P=0.04 for interaction), although the landmark analysis showed a trend towards benefit in both groups. Long term DAPT was associated with higher rates of major or minor bleeding, irrespective of diabetes (P=0.37 for interaction). Conclusions: Although the presence of diabetes emerged as an independent predictor of MACE after implantation of a drug eluting stent, compared with short term DAPT, long term DAPT did not reduce the risk of MACE but increased the risk of bleeding among patients with stents with and without diabetes.",
author = "Giuseppe Gargiulo and Stephan Windecker and {R Da Costa}, Bruno and Fausto Feres and Hong, {Myeong Ki} and Martine Gilard and K. ImHyo-Soo and Antonio Colombo and Bhatt, {Deepak L.} and Kim, {Byeong Keuk} and Morice, {Marie Claude} and Park, {Kyung Woo} and Alaide Chieffo and Tullio Palmerini and Stone, {Gregg W.} and Marco Valgimigli",
year = "2016",
month = "1",
day = "1",
doi = "10.1136/bmj.i5483",
language = "English",
volume = "355",
journal = "The BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

Gargiulo, G, Windecker, S, R Da Costa, B, Feres, F, Hong, MK, Gilard, M, ImHyo-Soo, K, Colombo, A, Bhatt, DL, Kim, BK, Morice, MC, Park, KW, Chieffo, A, Palmerini, T, Stone, GW & Valgimigli, M 2016, 'Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: Systematic review and meta-analysis of individual participant data from randomised trials', BMJ (Online), vol. 355, i5483. https://doi.org/10.1136/bmj.i5483

Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes : Systematic review and meta-analysis of individual participant data from randomised trials. / Gargiulo, Giuseppe; Windecker, Stephan; R Da Costa, Bruno; Feres, Fausto; Hong, Myeong Ki; Gilard, Martine; ImHyo-Soo, K.; Colombo, Antonio; Bhatt, Deepak L.; Kim, Byeong Keuk; Morice, Marie Claude; Park, Kyung Woo; Chieffo, Alaide; Palmerini, Tullio; Stone, Gregg W.; Valgimigli, Marco.

In: BMJ (Online), Vol. 355, i5483, 01.01.2016.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes

T2 - Systematic review and meta-analysis of individual participant data from randomised trials

AU - Gargiulo, Giuseppe

AU - Windecker, Stephan

AU - R Da Costa, Bruno

AU - Feres, Fausto

AU - Hong, Myeong Ki

AU - Gilard, Martine

AU - ImHyo-Soo, K.

AU - Colombo, Antonio

AU - Bhatt, Deepak L.

AU - Kim, Byeong Keuk

AU - Morice, Marie Claude

AU - Park, Kyung Woo

AU - Chieffo, Alaide

AU - Palmerini, Tullio

AU - Stone, Gregg W.

AU - Valgimigli, Marco

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective: To compare clinical outcomes between short term (up to 6 months) and long term (12 months) dual antiplatelet therapy (DAPT) after placement of a drug eluting stent in patients with and without diabetes. Design: Individual participant data meta-analysis. Cox proportional regression models stratified by trial were used to assess the impact of diabetes on outcomes. Data source: Medline, Embase, and Cochrane databases and proceedings of international meetings searched for randomised controlled trials comparing durations of DAPT after placement of a drug eluting stent. Individual patient data pooled from six DAPT trials. Primary outco me: Primary study outcome was one year risk of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, or definite/probable stent thrombosis. All analyses were conducted by intention to treat. Results: Six trials including 11 473 randomised patients were pooled. Of these patients, 3681 (32.1%) had diabetes and 7708 (67.2%) did not (mean age 63.7 (SD 9.9) and 62.8 (SD 10.1), respectively), and in 84 (0.7%) the information was missing. Diabetes was an independent predictor of MACE (hazard ratio 2.30, 95% confidence interval 1.01 to 5.27; P=0.048 At one year follow-up, long term DAPT was not associated with a decreased risk of MACE compared with short term DAPT in patients with (1.05, 0.62 to 1.76; P=0.86) or without (0.97, 0.67 to 1.39; P=0.85) diabetes (P=0.33 for interaction). The risk of myocardial infarction did not differ between the two DAPT regimens (0.95, 0.58 to 1.54; P=0.82; for those with diabetes and 1.15, 0.68 to 1.94; P=0.60; for those without diabetes (P=0.84 for interaction). There was a lower risk of definite/ probable stent thrombosis with long term DAPT among patients with (0.26, 0.09 to 0.80; P=0.02) than without (1.42, 0.68 to 2.98; P=0.35) diabetes, with positive interaction testing (P=0.04 for interaction), although the landmark analysis showed a trend towards benefit in both groups. Long term DAPT was associated with higher rates of major or minor bleeding, irrespective of diabetes (P=0.37 for interaction). Conclusions: Although the presence of diabetes emerged as an independent predictor of MACE after implantation of a drug eluting stent, compared with short term DAPT, long term DAPT did not reduce the risk of MACE but increased the risk of bleeding among patients with stents with and without diabetes.

AB - Objective: To compare clinical outcomes between short term (up to 6 months) and long term (12 months) dual antiplatelet therapy (DAPT) after placement of a drug eluting stent in patients with and without diabetes. Design: Individual participant data meta-analysis. Cox proportional regression models stratified by trial were used to assess the impact of diabetes on outcomes. Data source: Medline, Embase, and Cochrane databases and proceedings of international meetings searched for randomised controlled trials comparing durations of DAPT after placement of a drug eluting stent. Individual patient data pooled from six DAPT trials. Primary outco me: Primary study outcome was one year risk of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, or definite/probable stent thrombosis. All analyses were conducted by intention to treat. Results: Six trials including 11 473 randomised patients were pooled. Of these patients, 3681 (32.1%) had diabetes and 7708 (67.2%) did not (mean age 63.7 (SD 9.9) and 62.8 (SD 10.1), respectively), and in 84 (0.7%) the information was missing. Diabetes was an independent predictor of MACE (hazard ratio 2.30, 95% confidence interval 1.01 to 5.27; P=0.048 At one year follow-up, long term DAPT was not associated with a decreased risk of MACE compared with short term DAPT in patients with (1.05, 0.62 to 1.76; P=0.86) or without (0.97, 0.67 to 1.39; P=0.85) diabetes (P=0.33 for interaction). The risk of myocardial infarction did not differ between the two DAPT regimens (0.95, 0.58 to 1.54; P=0.82; for those with diabetes and 1.15, 0.68 to 1.94; P=0.60; for those without diabetes (P=0.84 for interaction). There was a lower risk of definite/ probable stent thrombosis with long term DAPT among patients with (0.26, 0.09 to 0.80; P=0.02) than without (1.42, 0.68 to 2.98; P=0.35) diabetes, with positive interaction testing (P=0.04 for interaction), although the landmark analysis showed a trend towards benefit in both groups. Long term DAPT was associated with higher rates of major or minor bleeding, irrespective of diabetes (P=0.37 for interaction). Conclusions: Although the presence of diabetes emerged as an independent predictor of MACE after implantation of a drug eluting stent, compared with short term DAPT, long term DAPT did not reduce the risk of MACE but increased the risk of bleeding among patients with stents with and without diabetes.

UR - http://www.scopus.com/inward/record.url?scp=84994634219&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994634219&partnerID=8YFLogxK

U2 - 10.1136/bmj.i5483

DO - 10.1136/bmj.i5483

M3 - Review article

C2 - 27811064

AN - SCOPUS:84994634219

VL - 355

JO - The BMJ

JF - The BMJ

SN - 0959-8146

M1 - i5483

ER -