Kheiri Babikir, Simpson Timothy F, Osman Mohammed, Golwala Harsh, Radaideh Qais, Kumar Kris, Rahmouni Hind, Divanji Punag, Cigarroa Joaquin E, Zahr Firas
Knight Cardiovascular Institute, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR, 97239, USA.
Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA.
J Thromb Thrombolysis. 2020 Nov;50(4):867-873. doi: 10.1007/s11239-020-02069-9.
Among patients who have undergone percutaneous coronary intervention (PCI), the use of dual antiplatelet therapy (DAPT) is associated with increased risk of bleeding, but decreased stent thrombosis and myocardial infarction unrelated to the stent. As PCI techniques and devices have progressed, the optimal duration of DAPT has come into question. We identified all randomized controlled trials (RCTs) of patients undergoing PCI, who received one or more drug eluting stents (DES) for stable coronary artery disease (CAD) or acute coronary syndrome (ACS), and randomized to short (1-3 months) versus standard duration DAPT. The prespecified primary outcome was major adverse cardiovascular events (MACE). Important secondary outcomes were net adverse clinical events (NACE) defined as MACE and major bleeding; any bleeding; major bleeding; all-cause death; cardiovascular death. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random-effects model. Analysis included 7 RCTs, comprising 35,857 patients and 53,321 patient-years of follow-up. The mean (SD) age of patients was 64.4 (10.6) years, 49.6% of patients presented with ACS, and 25.5% were female. There was no difference between short and standard-length DAPT in regards to MACE (HR = 0.93; 95% CI 0.84-1.03; p = 0.19), NACE (HR = 0.93; 95% CI 0.85-1.02; p = 0.12), all-cause death (HR = 0.92; 95% CI 0.80-1.05; p = 0.21), or cardiovascular death (HR = 0.85; 95% CI 0.64-1.13; p = 0.26). However, short-term DAPT was associated with significantly reduced major bleeding events (HR = 0.67; 95% CI 0.47-0.95; p = 0.03) and any bleeding event (HR = 0.63; 95% CI 0.44-0.90; p = 0.01) compared with standard-length DAPT. Among patients undergoing PCI for CAD, the use of short-term DAPT (1-3 months) followed by single antiplatelet therapy was associated with a lower incidence of clinically relevant bleeding events, but with similar risk of MACE, all-cause death, and cardiovascular death compared with standard duration DAPT.
在接受经皮冠状动脉介入治疗（PCI）的患者中，使用双联抗血小板治疗（DAPT）会增加出血风险，但会降低支架血栓形成以及与支架无关的心肌梗死风险。随着PCI技术和器械的发展，DAPT的最佳疗程成为了问题。我们纳入了所有针对接受PCI的患者进行的随机对照试验（RCT），这些患者因稳定型冠状动脉疾病（CAD）或急性冠状动脉综合征（ACS）接受了一个或多个药物洗脱支架（DES），并被随机分配接受短期（1 - 3个月）与标准疗程的DAPT。预先设定的主要结局是主要不良心血管事件（MACE）。重要的次要结局是定义为MACE和大出血的净不良临床事件（NACE）；任何出血；大出血；全因死亡；心血管死亡。我们使用随机效应模型计算风险比（HR）和95%置信区间（CI）。分析纳入了7项RCT，共35857例患者，随访时间总计53321患者年。患者的平均（标准差）年龄为64.4（10.6）岁，49.6%的患者表现为ACS，25.5%为女性。在MACE方面（HR = 0.93；95% CI 0.84 - 1.03；p = 0.19）、NACE方面（HR = 0.93；95% CI 0.85 - 1.02；p = 0.12）、全因死亡方面（HR = 0.92；95% CI 0.80 - 1.05；p = 0.21）或心血管死亡方面（HR = 0.85；95% CI 0.64 - 1.13；p = 0.26），短期与标准疗程DAPT之间没有差异。然而，与标准疗程DAPT相比，短期DAPT与显著减少的大出血事件（HR = 0.67；95% CI 0.47 - 0.95；p = 0.03）和任何出血事件（HR = 0.63；95% CI 0.44 - 0.90；p = 0.01）相关。在因CAD接受PCI的患者中，使用短期DAPT（1 - 3个月）后序贯单一抗血小板治疗与临床相关出血事件的发生率较低相关，但与标准疗程DAPT相比，MACE、全因死亡和心血管死亡的风险相似。
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