title: Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation: A meta-analysis and meta-regression.
abstract: BACKGROUND
  The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement.
  
  
  METHODS
  We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I) > 40 was identified, effects were obtained with random models.
  
  
  RESULTS
  Nine RCTs were included with total n = 19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95% 0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR 0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95% CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT.
  
  
  CONCLUSIONS
  DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY Division of Cardiology, Loyola University Stritch School of Medicine, Maywood, IL New York University School of Medicine Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, NY Deutsches Herzzentrum München, Technische Universität, Klinik für Herz- und Kreislauferkrankungen, Munich, Germany Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Villablanca
authors.forename: Daniele
authors.initials: D
authors.lastname: Massera
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Panagiota
authors.initials: P
authors.lastname: Christia
authors.forename: Irving
authors.initials: I
authors.lastname: Perez
authors.forename: Ningxin
authors.initials: N
authors.lastname: Wan
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz-Schüpke
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.forename: Anna E
authors.initials: AE
authors.lastname: Bortnick
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.forename: Richard
authors.initials: R
authors.lastname: Lucariello
authors.forename: Mark
authors.initials: M
authors.lastname: Menegus
authors.forename: Robert
authors.initials: R
authors.lastname: Pyo
authors.forename: Jose
authors.initials: J
authors.lastname: Wiley
authors.forename: Harish
authors.initials: H
authors.lastname: Ramakrishna
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D054855:Drug-Eluting Stents; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011475:Prosthesis Failure; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors