Dataset Information

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials.

ABSTRACT:

Background

Diabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant.

Objective

The purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation.

Methods

We searched PubMed, Embase, and the Cochrane Library for studies that compared short-term (? 6 months) and long-term (? 12 months) DAPT in patients with DM. The primary endpoints were late (31-365 days) and very late (> 365 days) stent thrombosis (ST). The secondary endpoints included myocardial infarction (MI), target vessel recanalization (TVR), all-cause death, and major bleeding.

Results

Six randomized controlled trials, with a total of 3,657 patients with DM, were included in the study. In terms of the primary endpoint, there was no significant difference between the two groups in late (OR 1.15, 95% CI: 0.42-3.19, P = 0.79) or very late (OR 2.18, 95% CI: 0.20-24.18; P = 0.53) ST. Moreover, there was no significant difference in the secondary endpoints, including MI (OR 1.11, 95% CI: 0.72-1.71, P = 0.63), TVR (OR 1.31, 95% CI: 0.82-2.07, P = 0.26), all-cause death (OR 1.03, 95% CI: 0.61-1.75, P = 0.90) and major bleeding (OR 1.07, 95% CI: 0.34-3.40, P = 0.90) between the two groups.

Conclusion

Our study demonstrated that compared with long-term DAPT, short-term DAPT had no significant difference in the clinical outcomes of patients with DM implanted with second-generation DES.

SUBMITTER: Zhang H

PROVIDER: S-EPMC7743959 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials.

Zhang Hongyu H Ke Junsong J Huang Jun J Xu Kai K Chen Yun Y

PloS one 20201216 12

<h4>Background</h4>Diabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant.<h4>Objective</h4>The purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation.<h4>Methods</h4>We searched PubMed, Embas ...[more]

PMID: 33326442

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Project description:BackgroundEnd-stage renal disease yields susceptibility to both ischemia and bleeding. The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients, who are usually excluded from randomized studies. Since recent studies implied the benefits of prolonged DAPT >12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT in dialysis patients with higher cardiovascular risks.MethodsIn this nationwide population-based study, we analyzed dialysis patients who underwent DES implantation from 2008 to 2015. Continued DAPT was compared with discontinued DAPT using landmark analyses, including free-of-event participants at 12 (n = 2246), 15 (n = 1925) and 18 months (n = 1692) after DES implantation. The primary outcome was major adverse cardiovascular events (MACEs): a composite of mortality, nonfatal myocardial infarction, coronary revascularization and stroke. Major bleeding was a safety outcome. Inverse probability of treatment weighting Cox regression was performed.ResultsMean follow-up periods were 278.3-292.4 days, depending on landmarks. Overall, incidences of major bleeding were far lower than those of MACE. Continued DAPT groups showed lower incidences of MACE and higher incidences of major bleeding, compared with discontinued DAPT groups. In Cox analyses, continued DAPT reduced the hazards of MACE at the 12- [hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.61-0.90; P = 0.003], 15- (HR = 0.78, 95% CI 0.64-0.96; P = 0.019) and 18-month landmarks (HR = 0.79, 95% CI 0.63-0.99; P = 0.041), but without a significant increase in major bleeding at 12 (HR = 1.39, 95% CI 0.90-2.16; P = 0.14), 15 (HR = 1.13, 95% CI 0.75-1.70; P = 0.55) or 18 months (HR = 1.27, 95% CI 0.83-1.95; P = 0.27).ConclusionsProlonged DAPT reduced MACE without significantly increasing major bleeding in patients who were event-free at 12 months after DES implantation. In deciding on DAPT duration, prolonged DAPT should be considered in dialysis patients.

Project description:Background: Patients with diabetes mellitus (DM) are known to be at high-risk for both ischemic and bleeding complications post-percutaneous coronary intervention (PCI). The ischemic benefit vs. bleeding risk associated with extended dual antiplatelet therapy (DAPT) in high-risk "TWILIGHT-like" patients with diabetes mellitus after PCI has not been established. Methods: All consecutive high-risk patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 through December 2013 were identified from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least one clinical and one angiographic feature based on the TWILIGHT trial selection criteria. The present analysis evaluated 3,425 diabetic patients with concomitant high-risk angiographic features who were event-free at 1 year after PCI. Median follow-up was 2.4 years. The primary effectiveness endpoint was a composite of death, myocardial infarction, or stroke (termed major adverse cardiac and cerebrovascular events), and primary safety endpoint was clinically relevant bleeding according to the Bleeding Academic Research Consortium types 2, 3, or 5. Results: On inverse probability of treatment weighting (IPTW) analysis, prolonged-term (>1-year) DAPT with aspirin and clopidogrel decreased the risk of primary effectiveness endpoint compared with shorter ( ≤ 1-year) DAPT [1.8 vs. 4.3%; hazard ratio (HR)IPTW: 0.381; 95% confidence interval (CI): 0.252-0.576; P < 0.001] and reduced cardiovascular death [0.1% vs. 1.8%; HRIPTW: 0.056 (0.016-0.193)]. Prolonged DAPT was also associated with a reduced risk of definite/probable stent thrombosis [0.2 vs. 0.7%; HRIPTW: 0.258 (0.083-0.802)] and non-significantly lower rate of myocardial infarction [0.5 vs. 0.8%; HRIPTW: 0.676 (0.275-1.661)]. There was no significant difference between groups in clinically relevant bleeding [1.1 vs. 1.1%; HRIPTW: 1.078 (0.519-2.241); P = 0.840). Similar results were observed in multivariable Cox proportional hazards regression model. Conclusion: Among high-risk PCI patients with diabetes mellitus without an adverse event through 1 year, extending DAPT >1-year significantly reduced the risk of major adverse cardiac and cerebrovascular events without an increase in clinically relevant bleeding, suggesting that such high-risk diabetic patients may be good candidates for long-term DAPT.

Dataset Information

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials.

Background

Objective

Methods

Results

Conclusion

Publications

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials.

Similar Datasets

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