title: Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: an individual patient data pairwise and network meta-analysis.
abstract: BACKGROUND
  Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE).
  
  
  OBJECTIVE
  This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis.
  
  
  METHODS
  Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis).
  
  
  RESULTS
  Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT.
  
  
  CONCLUSIONS
  Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.
authors: Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy.
authors: Tullio
authors: T
authors: Palmerini
authors: Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy.
authors: Diego
authors: D
authors: Sangiorgi
authors: Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.
authors: Marco
authors: M
authors: Valgimigli
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.
authors: Fausto
authors: F
authors: Feres
authors: Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.
authors: Alexandre
authors: A
authors: Abizaid
authors: Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.
authors: Ricardo A
authors: RA
authors: Costa
authors: Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors: Myeong-Ki
authors: MK
authors: Hong
authors: Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors: Byeong-Keuk
authors: BK
authors: Kim
authors: Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors: Yangsoo
authors: Y
authors: Jang
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
authors: Hyo-Soo
authors: HS
authors: Kim
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
authors: Kyung Woo
authors: KW
authors: Park
authors: Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy.
authors: Andrea
authors: A
authors: Mariani
authors: Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy.
authors: Diego
authors: D
authors: Della Riva
authors: Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
authors: Philippe
authors: P
authors: Genereux
authors: Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
authors: Martin B
authors: MB
authors: Leon
authors: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors: Deepak L
authors: DL
authors: Bhatt
authors: Oxford Heart Center, Oxford University, Oxford, United Kingdom.
authors: Umberto
authors: U
authors: Bendetto
authors: Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy.
authors: Claudio
authors: C
authors: Rapezzi
authors: Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: bleeding; major adverse cardiac event(s); stent thrombosis