Abstract
Diabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant. The purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation. We searched PubMed, Embase, and the Cochrane Library for studies that compared short-term (≤ 6 months) and long-term (≥ 12 months) DAPT in patients with DM. The primary endpoints were late (31-365 days) and very late (> 365 days) stent thrombosis (ST). The secondary endpoints included myocardial infarction (MI), target vessel recanalization (TVR), all-cause death, and major bleeding. Six randomized controlled trials, with a total of 3,657 patients with DM, were included in the study. In terms of the primary endpoint, there was no significant difference between the two groups in late (OR 1.15, 95% CI: 0.42-3.19, P = 0.79) or very late (OR 2.18, 95% CI: 0.20-24.18; P = 0.53) ST. Moreover, there was no significant difference in the secondary endpoints, including MI (OR 1.11, 95% CI: 0.72-1.71, P = 0.63), TVR (OR 1.31, 95% CI: 0.82-2.07, P = 0.26), all-cause death (OR 1.03, 95% CI: 0.61-1.75, P = 0.90) and major bleeding (OR 1.07, 95% CI: 0.34-3.40, P = 0.90) between the two groups. Our study demonstrated that compared with long-term DAPT, short-term DAPT had no significant difference in the clinical outcomes of patients with DM implanted with second-generation DES.
Highlights
Nowadays, drug-eluting stent (DES) is widely used in diabetic patients with coronary artery disease because of their lower restenosis and target lesion revascularization rates compared to bare-metal stents (BMS)
In terms of the primary endpoint, there was no significant difference between the two groups in late or very late stent thrombosis (ST)
All patients were implanted with a second-generation DES, such as everolimus-eluting stent (EES), biolimus-eluting stents (BES), or zotarolimus-eluting stents (ZES)
Summary
Drug-eluting stent (DES) is widely used in diabetic patients with coronary artery disease because of their lower restenosis and target lesion revascularization rates compared to bare-metal stents (BMS). The risk of thrombosis after second-generation DES implantation in patient with diabetes mellitus (DM) remains high. Due to the high platelet reactivity, increased thrombin activity, and decreased reactivity of antiplatelet drugs in patients with DM, these factors might lead to ischemic events [3]. How to prevent thromboembolism and adverse cardiovascular events after PCI in patients with DM is still worth investigating. Diabetes is considered to be a high-risk factor for thromboembolic events. Available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant
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