Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation

A meta-analysis and meta-regression

Pedro A. Villablanca, Daniele Massera, Verghese Mathew, Sripal Bangalore, Panagiota Christia, Irving Perez, Ningxin Wan, Stefanie Schulz-Schüpke, David F. Briceno, Anna Bortnick, Mario J. Garcia, Richard J. Lucariello, Mark A. Menegus, Robert Pyo, Jose M. Wiley, Harish Ramakrishna

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Background: The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement. Methods: We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I2)>40 was identified, effects were obtained with random models. Results: Nine RCTs were included with total n=19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95% 0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR 0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95% CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT. Conclusion: DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.

Original languageEnglish (US)
Article numbere5819
JournalMedicine (United States)
Volume95
Issue number52
DOIs
StatePublished - 2016

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Drug-Eluting Stents
Meta-Analysis
Confidence Intervals
Mortality
Percutaneous Coronary Intervention
Hemorrhage
Therapeutics
Stents
Thrombosis
Randomized Controlled Trials
Group Psychotherapy
Stroke
Odds Ratio
Myocardial Infarction
Regression Analysis
Databases

Keywords

  • Drug-Eluting Stent
  • Dual Antiplatelet Therapy
  • Percutaneous Coronary Intervention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation : A meta-analysis and meta-regression. / Villablanca, Pedro A.; Massera, Daniele; Mathew, Verghese; Bangalore, Sripal; Christia, Panagiota; Perez, Irving; Wan, Ningxin; Schulz-Schüpke, Stefanie; Briceno, David F.; Bortnick, Anna; Garcia, Mario J.; Lucariello, Richard J.; Menegus, Mark A.; Pyo, Robert; Wiley, Jose M.; Ramakrishna, Harish.

In: Medicine (United States), Vol. 95, No. 52, e5819, 2016.

Research output: Contribution to journalReview article

Villablanca, Pedro A. ; Massera, Daniele ; Mathew, Verghese ; Bangalore, Sripal ; Christia, Panagiota ; Perez, Irving ; Wan, Ningxin ; Schulz-Schüpke, Stefanie ; Briceno, David F. ; Bortnick, Anna ; Garcia, Mario J. ; Lucariello, Richard J. ; Menegus, Mark A. ; Pyo, Robert ; Wiley, Jose M. ; Ramakrishna, Harish. / Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation : A meta-analysis and meta-regression. In: Medicine (United States). 2016 ; Vol. 95, No. 52.
@article{ed336d48a13d4276a4134ca5849bbf2b,
title = "Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation: A meta-analysis and meta-regression",
abstract = "Background: The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement. Methods: We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95{\%} confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I2)>40 was identified, effects were obtained with random models. Results: Nine RCTs were included with total n=19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95{\%} confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95{\%} CI: 0.66-1.21), non-CV mortality (OR 0.85; 95{\%} 0.58-1.24), myocardial infarction (OR 1.10; 95{\%} CI: 0.89-1.37), stroke (OR 0.97; 95{\%} CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95{\%} CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95{\%} CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95{\%} CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95{\%} CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT. Conclusion: DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.",
keywords = "Drug-Eluting Stent, Dual Antiplatelet Therapy, Percutaneous Coronary Intervention",
author = "Villablanca, {Pedro A.} and Daniele Massera and Verghese Mathew and Sripal Bangalore and Panagiota Christia and Irving Perez and Ningxin Wan and Stefanie Schulz-Sch{\"u}pke and Briceno, {David F.} and Anna Bortnick and Garcia, {Mario J.} and Lucariello, {Richard J.} and Menegus, {Mark A.} and Robert Pyo and Wiley, {Jose M.} and Harish Ramakrishna",
year = "2016",
doi = "10.1097/MD.0000000000005819",
language = "English (US)",
volume = "95",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
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number = "52",

}

TY - JOUR

T1 - Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation

T2 - A meta-analysis and meta-regression

AU - Villablanca, Pedro A.

AU - Massera, Daniele

AU - Mathew, Verghese

AU - Bangalore, Sripal

AU - Christia, Panagiota

AU - Perez, Irving

AU - Wan, Ningxin

AU - Schulz-Schüpke, Stefanie

AU - Briceno, David F.

AU - Bortnick, Anna

AU - Garcia, Mario J.

AU - Lucariello, Richard J.

AU - Menegus, Mark A.

AU - Pyo, Robert

AU - Wiley, Jose M.

AU - Ramakrishna, Harish

PY - 2016

Y1 - 2016

N2 - Background: The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement. Methods: We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I2)>40 was identified, effects were obtained with random models. Results: Nine RCTs were included with total n=19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95% 0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR 0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95% CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT. Conclusion: DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.

AB - Background: The benefit of ≤6-month compared with 12-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement remains controversial. We performed a meta-analysis and meta-regression of ≤6-month versus 12-month DAPT in patients undergoing PCI with DES placement. Methods: We conducted electronic database searches of randomized controlled trials (RCTs) comparing DAPT durations after DES placement. For studies with longer follow-up, outcomes at 12 months were identified. Odds ratios and 95% confidence intervals were computed with the Mantel-Haenszel method. Fixed-effect models were used; if heterogeneity (I2)>40 was identified, effects were obtained with random models. Results: Nine RCTs were included with total n=19,224 patients. No significant differences were observed between ≤6-month compared with 12-month DAPT in all-cause mortality (OR 0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV) mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95% 0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR 0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI: 0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI: 0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI: 0.49-1.05) was observed, though the all-bleeding event rate was significantly lower in the ≤6-month DAPT group (OR 0.76; 95% CI: 0.59-0.96). In the meta-regression analysis, a significant association between bleeding events and non-CV mortality with 12-month DAPT was found, as well as between ST and mortality in addition to MI with ≤6-month DAPT. Conclusion: DAPT for ≤6 months is associated with similar mortality and ischemic outcomes but less bleeding events compared with 12-month DAPT after PCI with DES.

KW - Drug-Eluting Stent

KW - Dual Antiplatelet Therapy

KW - Percutaneous Coronary Intervention

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U2 - 10.1097/MD.0000000000005819

DO - 10.1097/MD.0000000000005819

M3 - Review article

VL - 95

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

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