Wassef Anthony W A, Khafaji Hadi, Syed Ishba, Yan Andrew T, Udell Jacob A, Goodman Shaun G, Cheema Asim N, Bagai Akshay
Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Invasive Cardiol. 2016 Dec;28(12):E203-E210. Epub 2016 Sep 15.
Current guidelines recommend 12 months of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Whether the duration of DAPT can be safely shortened with use of second-generation DESs is unclear.
We conducted a meta-analysis of randomized controlled trials comparing short duration (SD) (3-6 months) with standard longer duration (LD) (≥12 months) DAPT in patients treated with primarily second-generation DES implantation. Meta-regression was performed to explore the relationship between acute coronary syndrome (ACS) and the effect of DAPT duration.
Six studies were included, with 12,752/13,928 (91.5%) patients receiving second-generation DESs. A total of 5367 patients (39%) had PCI in the setting of ACS. There was no difference in all-cause mortality (1.1% vs 1.2%; odds ratio [OR], 0.86; 95% confidence interval [CI], 0.63-1.18; P=.36) or cardiac mortality (0.9% vs 1.0%; OR, 0.92; 95% CI, 0.61-1.39; P=.69) with SD-DAPT vs LD-DAPT, respectively. Definite/probable stent thrombosis (0.5% vs 0.3%; OR, 1.33; 95% CI, 0.75-2.34; P=.51), myocardial infarction (1.5% vs 1.3%; OR, 1.17; 95% CI, 0.88-1.56; P=.29), and stroke (0.4% vs 0.4%; OR, 1.04; 95% CI, 0.60-1.81; P=.88) were similar between the groups. Compared with LD-DAPT, SD-DAPT was associated with lower clinically significant bleeding (0.9% vs 1.4%; OR, 0.64; 95% CI, 0.46-0.89; P=.01). Meta-regression analysis showed no significant association between the proportion of ACS patients in trials and duration of DAPT for the outcomes of mortality (P=.95), myocardial infarction (P=.98), or stent thrombosis (P=.89).
In low-risk patients treated with contemporary second-generation DES implantation, SD-DAPT has similar rates of mortality, myocardial infarction, and stent thrombosis, with lower rates of bleeding compared with LD-DAPT.
当前指南推荐在药物洗脱支架（DES）植入的经皮冠状动脉介入治疗（PCI）后进行12个月的双联抗血小板治疗（DAPT）。使用第二代DES时DAPT疗程能否安全缩短尚不清楚。
我们对主要接受第二代DES植入治疗的患者中比较短疗程（SD）（3 - 6个月）与标准长疗程（LD）（≥12个月）DAPT的随机对照试验进行了荟萃分析。进行了荟萃回归以探讨急性冠状动脉综合征（ACS）与DAPT疗程效果之间的关系。
纳入了6项研究，12752/13928（91.5%）例患者接受第二代DES。共有5367例患者（39%）在ACS情况下接受了PCI。SD - DAPT与LD - DAPT相比，全因死亡率（1.1%对1.2%；优势比[OR]，0.86；95%置信区间[CI]，0.63 - 1.18；P = 0.36）或心脏死亡率（0.9%对1.0%；OR，0.92；95% CI，0.61 - 1.39；P = 0.69）无差异。明确/可能的支架血栓形成（0.5%对0.3%；OR，1.33；95% CI，0.75 - 2.34；P = 0.51）、心肌梗死（1.5%对1.3%；OR，1.17；95% CI，0.88 - 1.56；P = 0.29）和中风（0.4%对0.4%；OR，1.04；95% CI，0.60 - 1.81；P = 0.88）在两组之间相似。与LD - DAPT相比，SD - DAPT与较低的临床显著出血相关（0.9%对1.4%；OR，0.64；95% CI，0.46 - 0.89；P = 0.01）。荟萃回归分析显示，试验中ACS患者的比例与DAPT疗程对死亡率（P = 0.95）、心肌梗死（P = 0.98）或支架血栓形成（P = 0.89）结局之间无显著关联。
在接受当代第二代DES植入治疗的低风险患者中，SD - DAPT的死亡率、心肌梗死和支架血栓形成发生率相似，与LD - DAPT相比出血率较低。
