Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis

Tullio Palmerini, Diego Sangiorgi, Marco Valgimigli, Giuseppe Biondi-Zoccai, Fausto Feres, Alexandre Abizaid, Ricardo A. Costa, Myeong Ki Hong, Byeong Keuk Kim, Yangsoo Jang, Hyo Soo Kim, Kyung Woo Park, Andrea Mariani, Diego Della Riva, Philippe Genereux, Martin B. Leon, Deepak L. Bhatt, Umberto Bendetto, Claudio Rapezzi, Gregg W. Stone

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Abstract

Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

Original languageEnglish
Pages (from-to)1092-1102
Number of pages11
JournalJournal of the American College of Cardiology
Volume65
Issue number11
DOIs
Publication statusPublished - 2015 Mar 24

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, T., Sangiorgi, D., Valgimigli, M., Biondi-Zoccai, G., Feres, F., Abizaid, A., Costa, R. A., Hong, M. K., Kim, B. K., Jang, Y., Kim, H. S., Park, K. W., Mariani, A., Della Riva, D., Genereux, P., Leon, M. B., Bhatt, D. L., Bendetto, U., Rapezzi, C., & Stone, G. W. (2015). Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis. Journal of the American College of Cardiology, 65(11), 1092-1102. https://doi.org/10.1016/j.jacc.2014.12.046