Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation: A meta-analysis and meta-regression

Pedro A. Villablanca, Daniele Massera, Verghese Mathew, Sripal Bangalore, Panagiota Christia, Irving Perez, Ningxin Wan, Stefanie Schulz-Schüpke, David F. Briceno, Anna E. Bortnick, Mario J. Garcia, Richard Lucariello, Mark Menegus, Robert Pyo, Jose Wiley, Harish Ramakrishna

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Abstract

Background: The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement. Methods: We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I2)>40 was identified, effects were obtained with random models. Results: Nine RCTs were included with total n=19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95% 0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR 0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95% CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT. Conclusion: DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.

Original languageEnglish (US)
Article numbere5819
JournalMedicine (United States)
Volume95
Issue number52
DOIs
StatePublished - 2016

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Keywords

  • Drug-Eluting Stent
  • Dual Antiplatelet Therapy
  • Percutaneous Coronary Intervention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Villablanca, P. A., Massera, D., Mathew, V., Bangalore, S., Christia, P., Perez, I., Wan, N., Schulz-Schüpke, S., Briceno, D. F., Bortnick, A. E., Garcia, M. J., Lucariello, R., Menegus, M., Pyo, R., Wiley, J., & Ramakrishna, H. (2016). Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation: A meta-analysis and meta-regression. Medicine (United States), 95(52), [e5819]. https://doi.org/10.1097/MD.0000000000005819