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Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: an individual patient data pairwise and network meta-analysis

Authors
 Tullio Palmerini  ;  Diego Sangiorgi  ;  MStat  ;  Marco Valgimigli  ;  Giuseppe Biondi Zoccai  ;  Fausto Feres  ;  Alexandre Abizaid  ;  Ricardo A. Costa  ;  Myeong Ki Hong  ;  Byeong Keuk Kim  ;  Yangsoo Jang  ;  Hyo Soo Kim  ;  Kyung Woo Park  ;  Andrea Mariani  ;  Diego Della Riva  ;  Philippe Genereux  ;  Martin B. Leon  ;  Deepak L. Bhatt  ;  Umberto Bendetto  ;  Claudio Rapezzi  ;  Gregg W. Stone 
Citation
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.65(11) : 1092-1102, 2015 
Journal Title
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 
ISSN
 0735-1097 
Issue Date
2015
MeSH
Drug Administration Schedule ; Drug-Eluting Stents* ; Graft Occlusion, Vascular/mortality ; Graft Occlusion, Vascular/prevention & control* ; Humans ; Myocardial Infarction/mortality ; Myocardial Infarction/prevention & control* ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors/administration & dosage* ; Randomized Controlled Trials as Topic
Keywords
bleeding ; major adverse cardiac event(s) ; stent thrombosis
Abstract
BACKGROUND: Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). OBJECTIVES: This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. METHODS: Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). RESULTS: Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. CONCLUSIONS: Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.
Full Text
http://www.sciencedirect.com/science/article/pii/S0735109715001400
DOI
10.1016/j.jacc.2014.12.046
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139912
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