title: Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents.
abstract: The purpose of the study was to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention, especially in the era of second-generation drug-eluting stents (DES). The work was conducted from November 2014 to April 2015. All randomized controlled trials comparing short (<12 months) versus long (≥12 months) DAPT in patients treated with second-generation DES were analyzed. Sensitivity analyses were performed for length of DAPT and type of DES. All-cause death was the primary end point, whereas cardiovascular death, myocardial infarction (MI), stent thrombosis (ST), and major bleeding were secondary end points. Results were pooled and compared with random-effect models and meta-regression analysis. Eight randomized controlled trials with 18,810 randomized patients were included. The studies compared 3 versus 12 months of DAPT (2 trials), 6 versus 12 months (3 trials), 6 versus 24 months (1 trial), 12 versus 24 months (1 trial), and 12 versus 30 months (1 trial). Comparing short versus long DAPT, there were no significant differences in all-cause death (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.66 to 1.44), cardiovascular death (OR 0.95; 95% CI 0.65 to 1.37), and ST (OR 1.20; 95% CI 0.79 to 1.83), and no differences were present when considering everolimus-eluting and fast-release zotarolimus-eluting stents separately. Shorter DAPT was inferior to longer DAPT in preventing MI (OR 1.35; 95% CI 1.03 to 1.77). Conversely, major bleeding was reduced by shorter DAPT (OR 0.60; 95% CI 0.42 to 0.96). Baseline features did not influence these results in meta-regression analysis. In conclusion, DAPT for ≤6 months is reasonable for patients treated with everolimus-eluting and fast-release zotarolimus-eluting stents, with the benefit of less major bleeding at the cost of increased MI, with similar survival and ST rates. An individualized patient approach to DAPT duration should take into account the competing risks of bleeding and ischemic complications after present-generation DES.
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy. Electronic address: meshmeshaya11@yahoo.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, A.O.U San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bianco
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bernardi
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy; Division of Cardiology, Assuit University Hospital, Assuit, Egypt.
authors.forename: Salma
authors.initials: S
authors.lastname: Taha
authors.affiliation: Division of Cardiology, A.O.U San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montefusco
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Antonio H
authors.initials: AH
authors.lastname: Frangieh
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Cheol W
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Cardiology Department, Cardiovascular Institute, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy; Cardiology Department, LTTA Center, Ferrara, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milán, Italia.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Quadri
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavani
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giuseppe B
authors.initials: GB
authors.lastname: Zoccai
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milán, Italia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D003324:Coronary Artery Disease / Q000628:therapy*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D014943:Global Health; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011474:Prosthesis Design
chemical_list: D010975:Platelet Aggregation Inhibitors