Meta-Analysis of the Efficacy and Safety of P2Y12 Inhibitor Monotherapy After Short Course of Dual-Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention |
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| Institution: | 1. Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA;2. Departement of Cardiology, University of Toledo Medical Center, Toledo, OH, USA;3. Departement of Cardiology, Tanta University Hospital, Tanta, Egypt;4. Departement of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA;5. Tower Health/Reading Hospital, West Reading, PA, USA;1. Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;2. Vanderbilt University Medical Center, Nashville, TN, USA;3. VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA;4. Minneapolis Heart Institute, Minneapolis, MN, USA;5. Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA;6. Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA, USA;7. University of Arizona College of Medicine, Tucson, AZ, USA;1. Division of Cardiology, Duke University, Durham, NC, USA;2. Duke Clinical Research Institute, Duke University, Durham, NC, USA;3. Brigham and Women''s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA;4. Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden;5. FACT (French Alliance for Cardiovascular Clinical Trials), DHU FIRE, INSERM Unité 1148, Université Paris-Diderot, Hôpital Bichat, Assistance-Publique-Hôpitaux de Paris, France;6. NHLI, Imperial College, Royal Brompton Hospital, London, UK;7. Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA |
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| Abstract: | BackgroundGuidelines recommend dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) placement for ≥12 months in acute coronary syndrome or 6 months in stable coronary artery disease. However, with the advent of newer-generation stents, the optimal duration of DAPT to balance bleeding and thrombotic risks has been debated.ObjectivesWe aimed to perform a meta-analysis of randomized controlled trials (RCT) comparing P2Y12 monotherapy in short-duration group (SDG) vs. standard treatment group (STG) course of DAPT in patients undergoing PCI.MethodsElectronic databases were searched for RCTs of patients undergoing percutaneous coronary intervention (PCI) with DES placement who received short (≤ 3 months) vs. standard DAPT course (≥12 months) and were followed for ≥12-months. Rates of major adverse cardiovascular events (a composite of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke) were the primary outcome. Study-specific odds ratios (OR) and corresponding 95% confidence intervals were calculated using random-effects model.ResultsA total of 20,706 patients (10,344 in the SDG and 10,362 in the STG) were analysed from four studies. There was no significant difference observed for MACE (OR = 0.95, 95% CI: 0.81–1.08, P = .92, I2 = 0%) myocardial infarction or stent thrombosis. However, lower rates of major bleeding were noted in the SDG (1.20 vs. 1.80%; OR: 0.61; 95% CI: 0.37–0.99; P = .04; I2 = 71%) albeit with increased heterogeneity.ConclusionA short duration of DAPT followed by P2Y12 inhibitor monotherapy was comparable to 12 months of DAPT with respect to MACE and thrombotic events, with lower rates of major bleeding events in select group of patients undergoing PCI. More data is needed to assess efficacy in patients with complex lesions and high risk ACS population including those with STEMI presentation. |
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