第二代药物洗脱支架经皮冠状动脉介入治疗后短期与标准疗程双联抗血小板治疗的系统评价、Meta分析及Meta回归分析：一项随机对照试验研究

Short Duration vs Standard Duration of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents - A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Randomized Controlled Trials.

作者信息

Wassef Anthony W A, Khafaji Hadi, Syed Ishba, Yan Andrew T, Udell Jacob A, Goodman Shaun G, Cheema Asim N, Bagai Akshay

机构信息

Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada.

出版信息

J Invasive Cardiol. 2016 Dec;28(12):E203-E210. Epub 2016 Sep 15.

PMID:27630146

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

背景

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。

方法

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。

结果

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。