Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York.
Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York.
Am J Cardiol. 2020 Jul 15;127:25-29. doi: 10.1016/j.amjcard.2020.04.027. Epub 2020 Apr 22.
The optimal duration of dual antiplatelet therapy (DAPT) in the era of second-generation drug-eluting stents is a matter of considerable debate with more data suggesting a shorter period of DAPT is feasible. We performed a meta-analysis to evaluate DAPT compared with monotherapy with a P2Y12 inhibitor after a percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane Central were searched from inception to October 2019 to identify randomized controlled trials that compared outcomes of patients treated with either DAPT or monotherapy with a P2Y12 inhibitor following PCI. Primary outcomes of interest included major bleeding, ischemic events (myocardial infarction, stroke, stent thrombosis, major adverse cardiac events), and both all-cause and cardiovascular mortality. Event rates were extracted, and the Mantel-Haenszel fixed-effects model was used to perform a meta-analysis. Summary statistics are reported as odds ratios with 95% confidence intervals. Subgroup analyses were performed using the generic inverse method. We identified four trials with 29,089 randomized patients. Use of P2Y12 monotherapy was associated with 30% lower odds of major bleeding 0.70 (0.60-0.81; p <0.01). Ischemic and mortality outcomes were similar in the two groups. For the outcome of major bleeding the results favor the use of P2Y12 monotherapy in the subgroups of age, sex, diabetes, chronic kidney disease, acute coronary syndrome, and multivessel disease. The present meta-analysis provides the most updated data on the use of DAPT duration. Following an initial period of short-term DAPT, monotherapy with a P2Y12 inhibitor appears to be the superior strategy for optimization of bleeding and thrombotic risk after PCI.
在第二代药物洗脱支架时代，双联抗血小板治疗（DAPT）的最佳持续时间是一个备受争议的问题，更多数据表明较短的 DAPT 持续时间是可行的。我们进行了一项荟萃分析，以评估经皮冠状动脉介入治疗（PCI）后 DAPT 与 P2Y12 抑制剂单药治疗相比的效果。从开始到 2019 年 10 月，我们在 PubMed、Embase 和 Cochrane Central 上搜索了比较 PCI 后接受 DAPT 或 P2Y12 抑制剂单药治疗的患者结局的随机对照试验。主要关注的结局包括大出血、缺血事件（心肌梗死、卒中和支架血栓形成、主要不良心脏事件）以及全因和心血管死亡率。提取事件发生率，并使用固定效应模型进行荟萃分析。汇总统计数据以比值比（OR）及其 95%置信区间（CI）表示。使用通用逆方差法进行亚组分析。我们确定了四项包含 29089 名随机患者的试验。使用 P2Y12 单药治疗与大出血的几率降低 30%相关（OR 0.70，95%CI 0.60-0.81；p <0.01）。两组的缺血和死亡率结局相似。对于大出血的结局，在年龄、性别、糖尿病、慢性肾脏病、急性冠脉综合征和多血管疾病等亚组中，使用 P2Y12 单药治疗的结果更有利。本荟萃分析提供了关于 DAPT 持续时间使用的最新数据。在短期 DAPT 初始阶段后，P2Y12 抑制剂单药治疗似乎是 PCI 后优化出血和血栓风险的更佳策略。
