Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Nov;41(11):1455-1462.
doi: 10.1002/clc.23075. Epub 2018 Nov 20.

Efficacy and safety of short-term dual antiplatelet therapy (≤6 months) after percutaneous coronary intervention for acute coronary syndrome: A systematic review and meta-analysis of randomized controlled trials

Naoki Misumida  1 , Mohamed Abo-Aly  1 , Sun Moon Kim  1 , Gbolahan O Ogunbayo  1 , Ahmed Abdel-Latif  1 , Khaled M Ziada  1
Affiliations
Meta-Analysis

Efficacy and safety of short-term dual antiplatelet therapy (≤6 months) after percutaneous coronary intervention for acute coronary syndrome: A systematic review and meta-analysis of randomized controlled trials

Naoki Misumida et al. Clin Cardiol. 2018 Nov.

Abstract

Background: Patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are at increased risk for subsequent ischemic events.

Hypothesis: Short-term dual antiplatelet therapy (DAPT) (≤6 months) is inferior to standard or long-term DAPT in patients who undergo PCI for ACS events.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials that compared short-term (≤6 months) to long-term (≥12 months) DAPT after PCI for ACS. We searched MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials database.

Results: Ten randomized controlled trials, including a total of 12 696 patients, met our inclusion criteria. For short-term DAPT, duration of therapy ranged from 3 to 6 months, while long-term DAPT ranged from 12 to 24 months. The majority of studies used clopidogrel and second-generation drug-eluting stents. No statistically significant difference was found between short-term and long-term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94-1.57; P = 0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00-2.38; P = 0.052), or major bleeding events (odds ratio 0.74; 95% confidence interval 0.49-1.11; P = 0.14). There was no significant difference in all-cause mortality, cardiac death, or net adverse cardiac and cerebrovascular events.

Conclusions: Our meta-analysis demonstrated that short-term DAPT (<6 months) after PCI for ACS was not associated with increased risk of myocardial infarction or stent thrombosis when compared to long-term DAPT.

Keywords: acute coronary syndrome; dual antiplatelet therapy; percutaneous coronary intervention; stent thrombosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflict of interests.

Figures

Figure 1
Figure 1
Flow chart of search strategy. *Including two study protocols of unpublished data (REDUCE and DAPT STEMI trials). DAPT, dual antiplatelet therapy
Figure 2
Figure 2
Forest plot of myocardial infarction, stent thrombosis, and all‐cause mortality. No statistically significant difference was found between short‐term and long‐term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94‐1.57; P = 0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00‐2.38; P = 0.052). No significant heterogeneity was noted among studies with regard to myocardial infarction and stent thrombosis (I 2 index 0%). No significant difference was noted between the groups in all‐cause mortality. CI, confidence interval; DAPT, dual antiplatelet therapy
Figure 3
Figure 3
Forest plot of cardiac death, stroke, and major bleeding. No statistically significant difference was found between short‐term and long‐term DAPT with regard to major bleeding events (odds ratio 0.74; 95% confidence interval 0.49‐1.11; P = 0.14). No significant difference was noted between the groups in cardiac death or stroke. CI, confidence interval; DAPT, dual antiplatelet therapy
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;134:e123‐e155. - PubMed
    1. Colombo A, Chieffo A, Frasheri A, et al. Second‐generation drug‐eluting stent implantation followed by 6‐ Versus 12‐month dual antiplatelet therapy. J Am Coll Cardiol. 2014;64:2086‐2097. - PubMed
    1. Feres F, Costa RA, Abizaid A, et al. Three vs twelve months of dual antiplatelet therapy after zotarolimus‐eluting stents. JAMA. 2013;310:2510‐2522. - PubMed
    1. Ziada KM, Abdel‐Latif A, Charnigo R, Moliterno DJ. Safety of an abbreviated duration of dual antiplatelet therapy (≤6 months) following second‐generation drug‐eluting stents for coronary artery disease: a systematic review and meta‐analysis of randomized trials. Catheter Cardiovasc Interv. 2016;87:722‐732. - PMC - PubMed
    1. Kukreja N, Onuma Y, Garcia‐Garcia HM, Daemen J, van Domburg R, Serruys PW. Interventional Cardiologists of the Thoraxcenter (2000 to 2005). The risk of stent thrombosis in patients with acute coronary syndromes treated with bare‐metal and drug‐eluting stents. JACC Cardiovasc Interv. 2009;2:534‐541. - PubMed

MeSH terms

Substances

LinkOut - more resources