title: Discontinuation of dual antiplatelet therapy over 12 months after acute coronary syndromes increases risk for adverse events in patients treated with percutaneous coronary intervention: systematic review and meta-analysis.
abstract: BACKGROUND
  Duration of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) hospitalization remains to be defined, both for patients treated medically and for those undergoing percutaneous transluminal coronary angioplasty (PTCA).
  
  
  METHODS
  PubMed, Cochrane, and Google Scholar were systematically searched for studies including patients presenting with ACS, and treated either with DAPT longer than or shorter than 12 months. Multivariable-adjusted risk estimates for death and recurrent ACS with stopping DAPT after 12 months (odds ratios [OR] 95% confidence intervals [CI]) were pooled after logarithmic transformation according to random-effect models with inverse-variance weighting.
  
  
  RESULTS
  Five studies with 49,586 patients were included. Median age was 66 (64-67) years, with 67% (65-75) males. Myocardial infarction (MI) represented the admission diagnosis for 88% (60-100) of the patients, and 66% (50-74) were treated with stenting. After a follow-up of 2.1 years (1.5-2.7), 40% (35-46) still on DAPT after 12 months and the rates of death or recurrent ACS were 16.6 (14.5-17.0). Risk of adverse events for patients stopping DAPT after 1 year was significantly increased (OR = 1.19 [1.07-1.32]) for those receiving stents, but not for patients managed medically (OR = 1.13 [0.95-1.35]). The increased risk did not vary according to age, gender, myocardial infarction as admission diagnosis, and kind of stent.
  
  
  CONCLUSIONS
  Interruption of DAPT over 12 months after ACS increases the risk of adverse events for patients treated with PTCA, but not for those managed conservatively, independently from baseline features and admission diagnosis. This hypothesis-generating finding should be tested in randomized controlled trials.
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Delle Scienze San Giovanni Battista, Turin, Italy; Meta-analysis and Evidence Based Medicine Training in Cardiology (METCARDIO), Wegmans Pharmacy Ithaca, Ithaca, New York.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Colombo
authors.forename: Umberto
authors.initials: U
authors.lastname: Barbero
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reed
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: James J
authors.initials: JJ
authors.lastname: Di Nicolantonio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000145:classification / Q000627:therapeutic use; D012306:Risk; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D010975:Platelet Aggregation Inhibitors