Ticagrelor monotherapy after a short course of dual antiplatelet therapy with ticagrelor plus aspirin following percutaneous coronary intervention in patients with versus without diabetes mellitus: a meta-analysis of randomized trials

Abstract

Background: Cardiovascular disease (CVD) is one among the major causes of mortality all round the globe. Several anti-platelet regimens have been proposed following percutaneous coronary intervention (PCI). In this analysis, we aimed to show the adverse clinical outcomes associated with ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) with ticagrelor and aspirin following PCI in patients with versus without diabetes mellitus (DM).

Methods: Electronic databases were searched by four authors from September to November 2023. Cardiovascular outcomes and bleeding events were the endpoints of this analysis. Revman 5.4 software was used to conduct this meta-analysis. Risk ratio (RR) and 95% confidence intervals (CI) were used to represent the results which were generated.

Results: Three studies with a total number of 22,574 participants enrolled from years 2013 to 2019 were included in this analysis. Results of this analysis showed that DM was associated with significantly higher risks of major adverse cardiovascular events (RR: 1.73, 95% CI: 1.49 - 2.00; P = 0.00001), all-cause mortality (RR: 2.15, 95% CI: 1.73 - 2.66; P = 0.00001), cardiac death (RR: 2.82, 95% CI: 1.42 - 5.60; P = 0.003), stroke (RR: 1.78, 95% CI: 1.16 - 2.74; P = 0.009), myocardial infarction (RR: 1.63, 95% CI: 1.17 - 2.26; P = 0.004) and stent thrombosis (RR: 1.74, 95% CI: 1.03 - 2.94; P = 0.04) when compared to patients without DM. However, thrombolysis in myocardial infarction (TIMI) defined minor and major bleedings, bleeding defined according to the academic research consortium (BARC) type 3c (RR: 1.31, 95% CI: 0.14 - 11.90; P = 0.81) and BARC type 2, 3 or 5 (RR: 1.17, 95% CI: 0.85 - 1.62; P = 0.34) were not significantly different.

Conclusion: In patients who were treated with ticagrelor monotherapy after a short course of DAPT with ticagrelor and aspirin, DM was an independent risk factor for the significantly increased adverse cardiovascular outcomes. However, TIMI and BARC defined bleeding events were not significantly different in patients with versus without DM.

Keywords: Bleeding defined by the Academic Research Consortium; Bleeding risk; Cardiovascular events; Diabetes mellitus; Dual antiplatelet therapy; Major adverse cardiac events; Percutaneous coronary intervention; Thrombolysis in myocardial infarction; Ticagrelor monotherapy.

Fig. 1

Flow diagram showing the study selection for this meta-analysis

Fig. 2

Adverse cardiovascular outcomes with Ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) with Ticagrelor plus aspirin following percutaneous coronary intervention (PCI) in patients with versus without diabetes mellitus

Fig. 3

Myocardial infarction and stent thrombosis with Ticagrelor monotherapy after a short course of DAPT with Ticagrelor plus aspirin following PCI in patients with versus without diabetes mellitus

Fig. 4

Thrombolysis in myocardial infarction (TIMI) defined minor bleeding observed with Ticagrelor monotherapy after a short course of DAPT with Ticagrelor plus aspirin following PCI in patients with versus without diabetes mellitus

Fig. 5

TIMI defined major bleeding and bleeding defined by the academic research consortium (BARC) observed with Ticagrelor monotherapy after a short course of DAPT with Ticagrelor plus aspirin following PCI in patients with versus without diabetes mellitus

Fig. 6

Funnel plot showing publication bias (A)

Fig. 7

Funnel plot showing publication bias (B)