PCI术后不同持续时间双联抗血小板治疗的安全性和有效性的性别差异
Sex Differences in the Safety and Efficacy of Different Durations of DAPT After PCI.
作者信息
Park Dae Yong, Mahajan Shiwani, Fishman Emily, Ambrosini Alexander P, Romero Acero Laura M, Hu Jiun-Ruey, Campbell Greta, Babapour Golsa, Kelsey Michelle D, Douglas Pamela S, Gupta Aakriti, Frampton Jennifer, Nanna Michael G
机构信息
Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA.
出版信息
JACC Adv. 2025 Jan 8;4(2):101543. doi: 10.1016/j.jacadv.2024.101543. eCollection 2025 Feb.
BACKGROUND
Randomized controlled trials (RCTs) have examined the clinical impact of abbreviating the duration of dual antiplatelet therapy (DAPT) and have reported outcomes in men and women.
OBJECTIVES
The authors examined the safety and efficacy of different durations of DAPT following percutaneous coronary intervention (PCI) in men and women.
METHODS
We searched Cochrane, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases for RCTs that compared any 2 of 1, 3, 6, or 12 months of DAPT after PCI and reported outcomes in men and women. We performed a systematic review and network meta-analysis to examine sex-based differences in net adverse clinical events (NACE), major adverse cardiovascular events (MACE), and bleeding.
RESULTS
Fifteen RCTs were included, comprising 44,610 men (74.7%) and 15,132 women (25.3%). No difference in NACE or MACE was observed between 1, 3, 6, or 12 months of DAPT in both sexes. In both men and women, 1 and 3 months of DAPT were each associated with lower risk of bleeding compared with 12 months of DAPT. In women, 3 months of DAPT was associated with a lower risk of bleeding compared with 6 months. Similar results were found in sensitivity analysis of acute coronary syndrome-only trials.
CONCLUSIONS
No significant sex-based differences in NACE or MACE were observed with different durations of DAPT after PCI, while a lower bleeding risk was observed with shorter DAPT (1-3 months) among both sexes. This suggests that shorter DAPT may be preferred in both sexes following PCI, especially in those with high bleeding risk.
背景
随机对照试验（RCT）已研究了缩短双联抗血小板治疗（DAPT）疗程的临床影响，并报告了男性和女性的相关结果。
目的
作者研究了经皮冠状动脉介入治疗（PCI）后不同疗程的DAPT在男性和女性中的安全性和有效性。
方法
我们在Cochrane、Embase、MEDLINE、PubMed、Scopus和Web of Science数据库中检索RCT，这些试验比较了PCI后1、3、6或12个月DAPT中任意两种疗程，并报告了男性和女性的结果。我们进行了系统评价和网状荟萃分析，以研究净不良临床事件（NACE）、主要不良心血管事件（MACE）和出血方面基于性别的差异。
结果
纳入了15项RCT，包括44610名男性（74.7%）和15132名女性（25.3%）。在两性中，1、3、6或12个月的DAPT在NACE或MACE方面均未观察到差异。在男性和女性中，与12个月的DAPT相比，1个月和3个月的DAPT均与较低的出血风险相关。在女性中，与6个月的DAPT相比，3个月的DAPT与较低的出血风险相关。在仅针对急性冠状动脉综合征的试验的敏感性分析中也发现了类似结果。
结论
PCI后不同疗程的DAPT在NACE或MACE方面未观察到显著的基于性别的差异，而在两性中，较短疗程（1 - 3个月）的DAPT出血风险较低。这表明PCI后两性可能更倾向于较短疗程的DAPT，尤其是出血风险高的患者。
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