Center for Coronary Artery Disease, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
BMC Cardiovasc Disord. 2022 Feb 4;22(1):29. doi: 10.1186/s12872-022-02476-1.
To study the impact of de-escalation antiplatelet therapy retaining P2Y12 inhibition on major bleeding and ischemic outcomes after percutaneous coronary intervention (PCI) among East Asians and non-East Asians was unclear.
We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials through September 2020. Eight trials were included, which studied de-escalation of DAPT (D-DAPT, switching to P2Y12 inhibitor monotherapy, or switching to clopidogrel or dose reduction of the P2Y12 inhibitor after 1 to 3 months) versus 12 months standard DAPT (S-DAPT). The primary outcomes data was conducted using random effects models.
Among the 8 included trials consisting of 37,775 patients, 62.6% presented with acute coronary syndrome. The median follow-up duration ranged from 12 to 24 months. Compared with S-DAPT, D-DAPT was associated with a lower risk of major bleeding (RR = 0.67, 95% CI 0.48-0.93, p = 0.02); however, this was only observed among East-Asians (RR = 0.61, 95% CI 0.37-0.99, p = 0.048). Among non-East Asians, the rate of major bleeding was similar between the two groups (RR = 0.73, 95% CI 0.46-1.14, p = 0.17, p for interaction = 0.59). There were no significant differences in the major adverse cardiovascular events (MACE) between D-DAPT and S-DAPT treatment among both East Asians (RR = 0.84, 95% CI 0.66-1.08, p = 0.18) and non-East Asians (RR = 0.89, 95% CI 0.79-1.00, p = 0.059, p for interaction = 0.71).
The De-escalation strategy that retains P2Y12 inhibition after a PCI was associated with reduced risk of bleeding events, which was only demonstrated in East Asians patients, and not in non-East Asian patients.
在亚洲人和非亚洲人群中，经皮冠状动脉介入治疗（PCI）后，减少抗血小板治疗并保留 P2Y12 抑制作用对主要出血和缺血结局的影响尚不清楚。
我们系统地检索了 PubMed、Embase 和 Cochrane 图书馆截至 2020 年 9 月的随机对照试验。纳入了 8 项研究，这些研究比较了 DAPT 降级（D-DAPT，转换为 P2Y12 抑制剂单药治疗，或在 1 至 3 个月后转换为氯吡格雷或减少 P2Y12 抑制剂剂量）与 12 个月标准 DAPT（S-DAPT）。主要结局数据采用随机效应模型进行分析。
在纳入的 8 项试验中，共包括 37775 例患者，其中 62.6%为急性冠状动脉综合征患者。中位随访时间为 12 至 24 个月。与 S-DAPT 相比，D-DAPT 主要出血风险较低（RR=0.67，95%CI 0.48-0.93，p=0.02）；然而，这种结果仅在亚洲人群中观察到（RR=0.61，95%CI 0.37-0.99，p=0.048）。在非亚洲人群中，两组之间的主要出血发生率相似（RR=0.73，95%CI 0.46-1.14，p=0.17，p 交互作用=0.59）。在亚洲人群中（RR=0.84，95%CI 0.66-1.08，p=0.18）和非亚洲人群中（RR=0.89，95%CI 0.79-1.00，p=0.059，p 交互作用=0.71），D-DAPT 与 S-DAPT 治疗的主要不良心血管事件（MACE）发生率无显著差异。
PCI 后保留 P2Y12 抑制作用的降级策略与出血事件风险降低相关，这一结果仅在亚洲人群中得到证实，而非亚洲人群中则没有。
