Abstract 14885: Updated Meta-Analysis of 1 Month versus Greater Than 1 Month of Dual Anti-Platelet Therapy (DAPT) After Percutaneous Coronary Intervention Supports Shorter DAPT Duration

Abstract

Introduction: The ideal duration of dual anti-platelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains elusive, a balancing act between bleeding and ischemic risks. Recent evidence suggests a shorter duration may be safe. This updated meta-analysis evaluates the safety and efficacy of 1 month of DAPT in patients after PCI with a drug eluting stent. Hypothesis: 1 month of DAPT will be more favorable than greater than 1 month of DAPT Methods: This meta-analysis reviewed literature obtained systematically. Inclusion criteria encompassed randomized study designs comparing the efficacy of 1-month DAPT versus greater than 1-month of DAPT treatment in patients with PCI for stable coronary artery disease (CAD) or acute coronary syndrome (ACS), minimum follow-up of 12 months, and full-text studies published in peer-reviewed journals. Exclusion criteria include studies that did not include DAPT longer than 1-month, non-randomized studies, unpublished studies, and ongoing trials. We reviewed 96 articles; 7 were included in our meta-analysis. We included 2 more studies compared to the most recent meta-analysis. Our statistical analysis calculated weighted pooled risk ratios, confidence intervals, and p-values using the Mantel-Haenszel method. Results: The sample size was 24,412. The primary outcome of overall mortality favored 1 month of DAPT compared to greater than one month DAPT [RR 0.57, (CI 0.48-0.66) P<0.00001]. The secondary outcomes of cardiovascular death [RR 0.68, (CI 0.56-0.83) P=0.0001] and bleeding [RR 0.70, (CI 0.63-0.78) P<0.00001) favored 1 month of DAPT compared to greater than 1 month of DAPT. The secondary outcome of myocardial infarction [RR 1.25, (CI 1.08-1.44) P=0.002] favored greater than 1 month of DAPT compared to 1 month of DAPT. Stent thrombosis [RR 1.21, (CI 0.84-1.74) P= 0.31] did not meet statistical significance. Conclusions: Our meta-analysis suggests that 1 month of DAPT was associated with improved overall mortality, cardiovascular death and bleeding, at the expense of increased myocardial infarction. One month of DAPT is a reasonable treatment option for high bleeding risk patients undergoing PCI.