Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Abstract

The optimal duration of DAPT after complex PCI remains under investigation. The purpose of this systematic review and meta-analysis was to explore the safety and efficacy of a one-month therapy period versus a longer duration of DAPT after complex PCI. We systematically screened three major databases, searching for randomized controlled trials or sub-analyses of them, which compared shortened DAPT (S-DAPT), namely, one month, and longer DAPT (L-DAPT), namely, more than three months. The primary endpoint was any Net Adverse Clinical Event (NACE), and the secondary was any MACE (Major Adverse Cardiac Event), its components (mortality, myocardial infarction, stroke, and stent thrombosis), and major bleeding events. Three studies were included in the analysis, with a total of 6275 patients. Shortening DAPT to 30 days after complex PCI did not increase the risk of NACEs (OR: 0.77, 95% CI: 0.52-1.14), MACEs, mortality, myocardial infractions, stroke, or stent thrombosis. Pooled major bleeding incidence was reduced, but this finding was not statistically significant. This systematic review and meta-analysis showed that one-month DAPT did not differ compared to a longer duration of DAPT after complex PCI in terms of safety and efficacy endpoints. Further studies are still required to confirm these findings.

Keywords: PCI; bifurcations; chronic total occlusion; complex percutaneous coronary interventions; dual-antiplatelet therapy.

Figure 1

Forest plot demonstrating the effect of very short-term versus more than 3 months dual antiplatelet treatment on net adverse clinical events, with odds ratio and 95% confidence intervals. Each square represents a study; the size of square is representative of the weight of each study. The diamond shows the result when all the particular studies are combined together and averaged. CI, confidence interval; DAPT, dual antiplatelet therapy; M-H, Mantel–Haenszel.

Figure 2

Forest plot demonstrating the effect of very short-term versus more than 3-month dual antiplatelet treatment on major adverse clinical events, with odds ratio and 95% confidence intervals. CI, confidence interval; DAPT, dual antiplatelet therapy; M-H, Mantelel Haenszel; MACE, major adverse cardiovascular events.

Figure 3

Forest plot demonstrating the effect of very short-term versus more than 3-month dual antiplatelet treatment on all-cause mortality, with odds ratio and 95% confidence intervals. CI, confidence interval; DAPT, dual antiplatelet therapy; M-H, Mantelel Haenszel.

Figure 4

Forest plot demonstrating the effect of very short-term versus more than 3-month dual antiplatelet treatment on myocardial infarction (A) and stroke (B), with odds ratio and 95% confidence intervals. CI, confidence interval; DAPT, dual antiplatelet therapy; M-H, Mantelel Haenszel.

Figure 5

Forest plot demonstrating the effect of very short-term versus more than 3-month dual antiplatelet treatment on stent thrombosis, with odds ratio and 95% confidence intervals. CI, confidence interval; DAPT, dual antiplatelet therapy; M-H, Mantelel–Haenszel.

Figure 6

Forest plot demonstrating the effect of very short-term versus more than 3-month dual antiplatelet treatment on major bleedings, with odds ratio and 95% confidence intervals. CI, confidence interval; DAPT, dual antiplatelet therapy; M-H, Mantelel–Haenszel.