title: Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Patients With and Without Acute Coronary Syndrome: A Systematic Review of Randomized Controlled Trials.
abstract: In this systemic review we evaluated the efficacy and safety of long duration dual anti-platelet therapy (DAPT) (L-DAPT) compared with short duration DAPT (S-DAPT) after drug-eluting stent (DES) implantation in patients who presented with or without acute coronary syndromes (ACS). We identified 8 randomized controlled trials in which 30,975 patients were randomized to S-DAPT versus L-DAPT (12,421 ACS and 18,554 non-ACS). Short duration dual anti-platelet therapy was associated with an increase in target vessel revascularization (TVR) in ACS patients, but the difference was not significant for non-ACS patients (odds ratio [OR] 5.04 [95% CI, 1.28-19.76], and OR, 0.89 [95% CI, 0.51-1.55], respectively). The risk of cardiac mortality was not significantly different with S-DAPT and L-DAPT for ACS (OR, 1.69 [95% CI, 0.82-3.50]) and non-ACS patients (OR, 0.89 [95% CI, 0.57-1.37]). For all cause mortality, myocardial infarction, and stent thrombosis, most of the events were derived from the DAPT study, thus a meta-analysis was not performed for these end points. Based on our review of the literature, we conclude that S-DAPT was associated with higher rates of stent thrombosis and myocardial infarction, and non-significant differences in all-cause mortality, with no significant interactions according to ACS vs non-ACS. However, in non-ACS patients, the benefit-risk profile favored S-DAPT, with lower all-cause mortality, whereas the trends were reversed in ACS. Additional studies are required to determine if the benefit-risk profile of S-DAPT vs L-DAPT varies according to clinical syndrome.
authors: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York. Electronic address: abhisheksharma4mamc@gmail.com.
authors: Abhishek
authors: A
authors: Sharma
authors: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
authors: Carl J
authors: CJ
authors: Lavie
authors: Department of Cardiovascular Medicine, Heart & Vascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Samin K
authors: SK
authors: Sharma
authors: Department of Medicine, James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Akash
authors: A
authors: Garg
authors: Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH.
authors: Ajay
authors: A
authors: Vallakati
authors: Division of Cardiology, Texas Tech University, El Paso.
authors: Debabrata
authors: D
authors: Mukherjee
authors: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, New York.
authors: Jonathan D
authors: JD
authors: Marmur
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000592:standards; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D061214:Patient Safety; D010975:Platelet Aggregation Inhibitors / Q000592:standards / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors