Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310009, China.
School of Chinese Materia Medica, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing 210023, China.
J Interv Cardiol. 2021 May 5;2021:9934535. doi: 10.1155/2021/9934535. eCollection 2021.
This network meta-analysis aimed to evaluate the efficacy and safety of different dual antiplatelet therapies (DAPTs) after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs).
Randomized controlled trials (RCTs) comparing longer-term (>12 months) DAPT (L-DAPT), 12-month DAPT (DAPT 12Mo), 6-month DAPT (DAPT 6Mo), 3-month DAPT followed by aspirin monotherapy (DAPT 3Mo + ASA), 3-month DAPT followed by a P2Y12 receptor inhibitor monotherapy (DAPT 3Mo + P2Y12), or 1-month DAPT with a P2Y12 receptor inhibitor monotherapy (DAPT 1Mo + P2Y12) were searched. Primary endpoints were all-cause mortality, cardiac death, myocardial infarction (MI), major bleeding, any bleeding, definite or probable stent thrombosis (ST), and net adverse clinical events (NACE). This Bayesian network meta-analysis was performed with the random-effects model.
Twenty-four RCTs ( = 81339) were included. In comparison with L-DAPT, DAPT 6Mo (OR: 0.50, 95% CI: 0.29-0.83), DAPT 3Mo + P2Y12 (OR: 0.38, 95% CI: 0.18-0.82), DAPT 3Mo + ASA (OR: 0.44, 95% CI: 0.17-0.98), and DAPT 1Mo + P2Y12 (OR: 0.45, 95% CI: 0.14-0.93) were associated with a lower risk of major bleeding. DAPT 3Mo + P2Y12 (OR: 0.58, 95% CI: 0.38-0.88) reduced the risk of any bleeding when compared with DAPT 12Mo. L-DAPT decreased the risk of MI and definite or probable stent ST when compared with DAPT 6Mo. DAPT 3Mo + P2Y12 decreased the risk of NACE in comparison with DAPT 6Mo and DAPT 12Mo. No significant difference in all-cause mortality and cardiac death was observed. In patients with acute coronary syndrome, DAPT 6Mo was comparable to DAPT 12Mo.
Short-term (1-3 months) DAPT is noninferior to DAPT 6Mo after DESs implantation, while L-DAPT reduces MI and definite or probable ST rates. DAPT 3Mo + P2Y12 might be a reasonable trade-off in patients with high risk of bleeding accompanied by ischemia.
本网络荟萃分析旨在评估药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）后不同双联抗血小板治疗（DAPT）的疗效和安全性。
检索了比较长期（>12 个月）DAPT（L-DAPT）、12 个月 DAPT（DAPT 12Mo）、6 个月 DAPT（DAPT 6Mo）、3 个月 DAPT 后阿司匹林单药治疗（DAPT 3Mo+ASA）、3 个月 DAPT 后 P2Y12 受体抑制剂单药治疗（DAPT 3Mo+P2Y12）、或 1 个月 P2Y12 受体抑制剂单药治疗（DAPT 1Mo+P2Y12）的随机对照试验（RCT）。主要终点为全因死亡率、心脏死亡、心肌梗死（MI）、大出血、任何出血、明确或可能的支架血栓形成（ST）和净不良临床事件（NACE）。本贝叶斯网络荟萃分析采用随机效应模型进行。
共纳入 24 项 RCT（n=81339）。与 L-DAPT 相比，DAPT 6Mo（OR：0.50，95%CI：0.29-0.83）、DAPT 3Mo+P2Y12（OR：0.38，95%CI：0.18-0.82）、DAPT 3Mo+ASA（OR：0.44，95%CI：0.17-0.98）和 DAPT 1Mo+P2Y12（OR：0.45，95%CI：0.14-0.93）与大出血风险降低相关。与 DAPT 12Mo 相比，DAPT 3Mo+P2Y12（OR：0.58，95%CI：0.38-0.88）降低了任何出血的风险。与 DAPT 6Mo 相比，L-DAPT 降低了 MI 和明确或可能的支架 ST 的风险。与 DAPT 6Mo 和 DAPT 12Mo 相比，DAPT 3Mo+P2Y12 降低了 NACE 的风险。全因死亡率和心脏死亡率无显著差异。在急性冠状动脉综合征患者中，DAPT 6Mo 与 DAPT 12Mo 相当。
DES 植入后短期（1-3 个月）DAPT 与 DAPT 6Mo 相当，而 L-DAPT 降低了 MI 和明确或可能的 ST 发生率。DAPT 3Mo+P2Y12 可能是伴有缺血的高出血风险患者的合理选择。
