Spagnolo Marco, Laudani Claudio, Imbesi Antonino, Di Leo Giacinto, Ammirabile Nicola, Finocchiaro Simone, Mauro Maria Sara, Mazzone Placido Maria, Greco Antonio, Giacoppo Daniele, Capodanno Davide
Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico 'Rodolico - San Marco', University of Catania, Catania, Italy.
J Cardiovasc Med (Hagerstown). 2025 Jul 1;26(7):339-348. doi: 10.2459/JCM.0000000000001737. Epub 2025 May 21.
De-escalation of dual antiplatelet therapy (DAPT) by early discontinuation of one antiplatelet agent has been proposed as an alternative to 12-month DAPT to balance ischemic and bleeding risks in patients with acute coronary syndrome (ACS). However, the efficacy and safety of abbreviated DAPT regimens in ST-elevation myocardial infarction (STEMI) - a subset of ACS with distinct clinical and risk profiles - remain uncertain.
Randomized trials and sub-analyses of randomized trials comparing DAPT de-escalation by early discontinuation versus 12-month DAPT in patients with STEMI treated with primary angioplasty were included. Co-primary endpoints were major bleeding and major adverse cardiovascular events (MACE). Secondary endpoints included net adverse clinical events (NACE), individual ischemic outcomes, and clinically relevant bleeding. Trial sequential analysis (TSA) and sensitivity analyses were prespecified (CRD42024608709).
Eight randomized trials encompassing 10,216 patients were included. Short DAPT regimens significantly reduced major bleeding [hazard ratio, 0.50; 95% confidence interval (CI), 0.30-0.85; P = 0.011] compared with standard DAPT. No significant differences were observed in MACE (hazard ratio, 1.21; 95% CI, 0.91-1.64; P = 0.193) or NACE (hazard ratio, 0.94; 95% CI, 0.80-1.10; P = 0.427). The results of TSA reinforced these findings. Other secondary outcomes showed no significant differences, but interpretation was limited by the small number of studies reporting these events.
Abbreviated DAPT significantly reduces major bleeding risk in patients with STEMI compared with standard 12-month DAPT, without apparently compromising ischemic protection. However, further research is needed to clarify net clinical outcomes in this high-risk ACS subset.
CRD42024608709.
通过早期停用一种抗血小板药物来降低双联抗血小板治疗（DAPT）强度，已被提议作为12个月DAPT的替代方案，以平衡急性冠状动脉综合征（ACS）患者的缺血和出血风险。然而，在ST段抬高型心肌梗死（STEMI）（ACS的一个具有独特临床和风险特征的亚组）中，缩短疗程的DAPT方案的疗效和安全性仍不确定。
纳入了比较早期停用抗血小板药物以降低DAPT强度与12个月DAPT的随机试验及随机试验的亚分析，这些试验的对象为接受直接经皮冠状动脉介入治疗的STEMI患者。共同主要终点为大出血和主要不良心血管事件（MACE）。次要终点包括净不良临床事件（NACE）、个体缺血结局和临床相关出血。预先设定了序贯试验分析（TSA）和敏感性分析（CRD42024608709）。
纳入了八项随机试验，共10216例患者。与标准DAPT相比，缩短疗程的DAPT方案显著降低了大出血风险[风险比，0.50；95%置信区间（CI），0.30 - 0.85；P = 0.011]。在MACE（风险比，1.21；95% CI，0.91 - 1.64；P = 0.193）或NACE（风险比，0.9
