Journal article
Meta-Analysis of the Efficacy and Safety of P2Y 12 Inhibitor Monotherapy After Short Course of Dual-Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention
Cardiovascular revascularization medicine, v 21(12), pp 1500-1506
Dec 2020
PMID: 32457020
Abstract
Guidelines 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.
We aimed to perform a meta-analysis of randomized controlled trials (RCT) comparing P2Y
monotherapy in short-duration group (SDG) vs. standard treatment group (STG) course of DAPT in patients undergoing PCI.
Electronic 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.
A 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, I
= 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; I
= 71%) albeit with increased heterogeneity.
A short duration of DAPT followed by P2Y
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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Details
- Title
- Meta-Analysis of the Efficacy and Safety of P2Y 12 Inhibitor Monotherapy After Short Course of Dual-Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention
- Creators
- Ahmed M Elzanaty - University of Toledo Medical CenterSalik Nazir - University of Toledo Medical CenterMohammed T Awad - University of Toledo Medical CenterEman Elsheikh - Tanta University HospitalKeerat Rai Ahuja - Cleveland ClinicAnthony Donato - Reading HospitalEhab A Eltahawy (Corresponding Author) - University of Toledo Medical Center
- Publication Details
- Cardiovascular revascularization medicine, v 21(12), pp 1500-1506
- Publisher
- Elsevier
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); General Internal Medicine
- Web of Science ID
- WOS:000600651500007
- Other Identifier
- 991022161839004721