One month versus Six to Twelve months of Dual antiplatelet therapy after Percutaneous Coronary Intervention with Drug eluting stent: A Meta-Analysis of Randomized control trials
Presenter
Raahat Bansal, MD, CHI Health Creighton University Medical Center, Omaha, NE
Raahat Bansal, MD1, Rosa Natalia Cruz Torres, MD2, Abhishek Thandra, MD1, Shiva Ponamgi, MBBS1, Himanshu Agarwal, MD3 and Venkata M Alla, MD4, (1)CHI Health Creighton University Medical Center, Omaha, NE, (2)CHI Health Creighton University Medical Center - Bergan Mercy, omaha, NE, (3)-, Omaha, NE, (4)Creighton University, Omaha, NE
Keywords: Coronary, Drug-eluting Stent (DES) and Pharmacotherapy
Background
The current ACC/AHA/SCAI guidelines recommend dual anti-platelet therapy (DAPT) for 6 months in stable ischemic heart disease (SIHD) and 12 months in acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). We conducted a meta-analysis to determine the appropriate minimal duration of DAPT after PCI with drug eluting stent (DES).
Methods
PubMed, Google scholar and Cochrane databases were searched for all studies comparing DAPT for 1 month versus 6-12 months after PCI. The primary outcome of interest was 1-year all-cause mortality. The secondary outcomes were 1-year rates of stent thrombosis, bleeding, myocardial infarction (MI), stroke and target vessel revascularization (TVR). Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model.
Results
Three randomized controlled studies with 21,997 patients (1-month DAPT: 10987, 6-12 months DAPT: 11010) were included in the meta-analysis. Around 44% of patients included in the analysis presented with ACS. At 1-year follow up, the rates of all-cause mortality (RR 0.84, 95% CI 0.67-1.05, p=0.13), bleeding (RR 0.63, 95% CI 0.37-1.05, p=0.08), stroke (RR 0.87, 95% CI 0.59-1.29, p=0.48) and TVR (RR 0.90, 95% CI 0.77-1.04, p=0.16) were numerically lower but did not attain statistical significance in the 1-month DAPT group. The 1-year rates of stent thrombosis and MI are similar in both the treatment strategies. [Figure 1]
Conclusions
Our analysis suggests that discontinuing DAPT after 1-month can be a safe strategy after PCI particularly in those with high bleeding risk
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