The optimal duration of dual antiplatelet therapy after PCI with drug-eluting stent: a systematic review and Bayesian network meta-analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Objective We aimed to test the optimal duration of dual antiplatelet therapy (DAPT) on long-term clinical outcomes after implantation of drug-eluting stents (DES). Methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science through November 8th, 2021 to identify randomized controlled trials (RCT) assessing the duration of DAPT in patients receiving DES. Efficacy of all DAPT strategies was reported as pooled odd ratios (OR) with 95% credible interval (CrI) to summarize the effect of each strategy tested. Results We identified 24 RCTs containing 81405 patients. In comparison with 12-month DAPT, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce net clinical events (OR: 0.72; CrI: 0.55-0.94) and major bleeding (OR: 0.57; CrI: 0.34-1.00) without increasing ischeamic events (OR: 0.93; CrI: 0.68-1.29). Although >12-month DAPT was associated with a lower risk of myocardial infarction (OR: 0.67; CrI: 0.51-0.93), yet the risk of major bleeding (OR: 1.70; CrI: 1.10-2.70) was also increased, which is more strongly related to all-cause death than ischeamic events. Moreover, the benefits of 3-month DAPT (P2Y12 Inhibitor) were consistent for male patients with acute coronary disease, young age, complex lesion, single vessel disease, low body mass index, without diabetes. Conclusion Among patients treated with DES, 3-month DAPT followed by P2Y12 inhibitor monotherapy could reduce the risk of net clinical events without increasing ischeamic events. DAPT beyond one year reduced myocardial infarction at the expense of increased major bleeding. Taken together, 3-month DAPT followed by P2Y12 inhibitor monotherapy may be the optimal strategy for patients receiving DES.