title: Short Duration vs Standard Duration of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents - A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Current guidelines recommend 12 months of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Whether the duration of DAPT can be safely shortened with use of second-generation DESs is unclear.
  
  
  METHODS
  We conducted a meta-analysis of randomized controlled trials comparing short duration (SD) (3-6 months) with standard longer duration (LD) (≥12 months) DAPT in patients treated with primarily second-generation DES implantation. Meta-regression was performed to explore the relationship between acute coronary syndrome (ACS) and the effect of DAPT duration.
  
  
  RESULTS
  Six studies were included, with 12,752/13,928 (91.5%) patients receiving second-generation DESs. A total of 5367 patients (39%) had PCI in the setting of ACS. There was no difference in all-cause mortality (1.1% vs 1.2%; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.63-1.18; P=.36) or cardiac mortality (0.9% vs 1.0%; OR, 0.92; 95% CI, 0.61-1.39; P=.69) with SD-DAPT vs LD-DAPT, respectively. Definite/probable stent thrombosis (0.5% vs 0.3%; OR, 1.33; 95% CI, 0.75-2.34; P=.51), myocardial infarction (1.5% vs 1.3%; OR, 1.17; 95% CI, 0.88-1.56; P=.29), and stroke (0.4% vs 0.4%; OR, 1.04; 95% CI, 0.60-1.81; P=.88) were similar between the groups. Compared with LD-DAPT, SD-DAPT was associated with lower clinically significant bleeding (0.9% vs 1.4%; OR, 0.64; 95% CI, 0.46-0.89; P=.01). Meta-regression analysis showed no significant association between the proportion of ACS patients in trials and duration of DAPT for the outcomes of mortality (P=.95), myocardial infarction (P=.98), or stent thrombosis (P=.89).
  
  
  CONCLUSIONS
  In low-risk patients treated with contemporary second-generation DES implantation, SD-DAPT has similar rates of mortality, myocardial infarction, and stent thrombosis, with lower rates of bleeding compared with LD-DAPT.
authors.forename: Anthony W A
authors.initials: AW
authors.lastname: Wassef
authors.forename: Hadi
authors.initials: H
authors.lastname: Khafaji
authors.forename: Ishba
authors.initials: I
authors.lastname: Syed
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Udell
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada. bagaia@smh.ca.
authors.forename: Akshay
authors.initials: A
authors.lastname: Bagai
mesh_terms: D003327:Coronary Disease / Q000601:surgery*; D023903:Coronary Restenosis / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000379:methods*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors