Short versus 1-Year Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis

Abstract

Current guidelines recommend dual antiplatelet therapy (DAPT) for 6 to 12 months post percutaneous coronary intervention (PCI), with recent trials assessing the safety and efficacy of shortening DAPT duration to ≤3 months. A systematic search of PubMed, Scopus, and Cochrane Central databases identified studies comparing short DAPT followed by P2Y12i monotherapy (78% ticagrelor) vs. standard 12-month DAPT in patients undergoing PCI with drug-eluting stent (DES). Nine randomized controlled trials, including 42,770 patients (short DAPT n=21,370, 49.96%) of whom 28,307 (66.18%) presented with acute coronary syndrome (ACS), were included. Short DAPT significantly reduced NACE (RR 0.78; 95%CI 0.67-0.91; p=0.001; I2=62%), major bleeding (RR 0.54; 95%CI 0.39-0.73; p<0.001; I2=63%) as well as any bleeding (RR 0.55; 95%CI 0.43-0.72; p<0.001; I2=77%)​​ at 12 months compared with 1-year DAPT. No significant differences were observed in MACCE, myocardial infarction, stroke, stent thrombosis, mortality, or revascularization. Ticagrelor monotherapy after short DAPT further reduced MACCE (RR 0.85, 95% CI 0.73-0.99, p=0.040; I²=22%), NACE (RR 0.74, 95% CI 0.61-0.89, p=0.001; I²=68%), and major bleeding (RR 0.56, 95% CI 0.40-0.78, p<0.001; I²=71%) compared with 1-year DAPT, however, the test for subgroup interaction (Pinteraction>0.05) for clopidogrel subgroup was not significant. P2Y12i monotherapy reduced the risk of NACE (RR 0.77; 95%CI 0.66-0.90; p=0.001; I2=52%, Pinteraction=0.58) and major bleeding (RR 0.44; 95%CI 0.35-0.55; p<0.001; I2=0%, Pinteraction<0.01) in the ACS cohort, but not in the CCS cohort. In conclusion, short DAPT for ≤3 months followed by P2Y12i monotherapy (particularly ticagrelor) was associated with decreased NACE and bleeding without differences in other outcomes and should be considered a favorable option in patients with either ACS or CCS following PCI with DES.