Ontology highlight
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.Conclusion
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.
SUBMITTER: Villablanca PA
PROVIDER: S-EPMC5207602 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
Villablanca Pedro A PA Massera Daniele D Mathew Verghese V Bangalore Sripal S Christia Panagiota P Perez Irving I Wan Ningxin N Schulz-Schüpke Stefanie S Briceno David F DF Bortnick Anna E AE Garcia Mario J MJ Lucariello Richard R Menegus Mark M Pyo Robert R Wiley Jose J Ramakrishna Harish H
Medicine 20161201 52
<h4>Background</h4>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.<h4>Methods</h4>We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with lon ...[more]