Optimal duration of dual antiplatelet therapy followed by monotherapy in diabetic patients after percutaneous coronary intervention with drug‑eluting stent implantation: a Bayesian network meta-analysis.

INTRODUCTION

The standard 12-month dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation that is recommended for the general population may not be suitable for patients with diabetes.

OBJECTIVES

The study aimed to evaluate the efficacy and safety of short-term (≤3 months), medium-term (6 months), standard-term (12 months), and extended-term (>12 months) DAPT in diabetic patients with DES implantation and to compare the outcomes of DAPT discontinuation followed by monotherapy with aspirin versus a P2Y12 receptor inhibitor.

PATIENTS AND METHODS

Randomized controlled trials published up to October 10, 2020 were searched in the PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov databases. A Bayesian network meta-analysis with a random-effects model was performed. A total of 18 randomized trials involving 20 536 patients with diabetes were included.

RESULTS

The network analysis showed that short-term DAPT was the most optimal in terms of reducing the primary endpoint and was superior to extended-term DAPT (odds ratio [OR], 0.48; 95% CI, 0.25–0.85). Standard-term DAPT was also associated with a reduced primary endpoint in comparison with extended-term DAPT (OR, 0.56; 95% CI, 0.32–0.90). There was no noticeable difference with respect to the primary endpoint between short-term DAPT followed by monotherapy with aspirin and a P2Y12 inhibitor. No significant differences were observed in secondary endpoints, including all-cause mortality, cardiac mortality, myocardial infarction, stroke, target vessel revascularization, definite or probable stent thrombosis, and major bleeding event.

CONCLUSIONS

Short-term DAPT, as compared with extended-term therapy, was associated with a reduced primary endpoint in patients with diabetes after PCI with DES implantation.