Cited 356 times in
Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials
DC Field | Value | Language |
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dc.contributor.author | 김병극 | - |
dc.contributor.author | 장양수 | - |
dc.contributor.author | 홍명기 | - |
dc.date.accessioned | 2016-02-04T11:27:29Z | - |
dc.date.available | 2016-02-04T11:27:29Z | - |
dc.date.issued | 2015 | - |
dc.identifier.issn | 0140-6736 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/140466 | - |
dc.description.abstract | BACKGROUND: Despite recent studies, the optimum duration of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent placement remains uncertain. We performed a meta-analysis with several analytical approaches to investigate mortality and other clinical outcomes with different DAPT strategies. METHODS: We searched Medline, Embase, Cochrane databases, and proceedings of international meetings on Nov 20, 2014, for randomised controlled trials comparing different DAPT durations after drug-eluting stent implantation. We extracted study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes. DAPT duration was categorised in each study as shorter versus longer, and as 6 months or shorter versus 1 year versus longer than 1 year. Analyses were done by both frequentist and Bayesian approaches. FINDINGS: We identified ten trials published between Dec 16, 2011, and Nov 16, 2014, including 31,666 randomly assigned patients. By frequentist pairwise meta-analysis, shorter DAPT was associated with significantly lower all-cause mortality compared with longer DAPT (HR 0·82, 95% CI 0·69-0·98; p=0·02; number needed to treat [NNT]=325), with no significant heterogeneity apparent across trials. The reduced mortality with shorter compared with longer DAPT was attributable to lower non-cardiac mortality (0·67, 0·51-0·89; p=0·006; NNT=347), with similar cardiac mortality (0·93, 0·73-1·17; p=0.52). Shorter DAPT was also associated with a lower risk of major bleeding, but a higher risk of myocardial infarction and stent thrombosis. We noted similar results in a Bayesian framework with non-informative priors. By network meta-analysis, patients treated with 6-month or shorter DAPT and 1-year DAPT had higher risk of myocardial infarction and stent thrombosis but lower risk of mortality compared with patients treated with DAPT for longer than 1 year. Patients treated with DAPT for 6 months or shorter had similar rates of mortality, myocardial infarction, and stent thrombosis, but lower rates of major bleeding than did patients treated with 1-year DAPT. INTERPRETATION: Although treatment with DAPT beyond 1 year after drug-eluting stent implantation reduces myocardial infarction and stent thrombosis, it is associated with increased mortality because of an increased risk of non-cardiovascular mortality not offset by a reduction in cardiac mortality. | - |
dc.description.statementOfResponsibility | open | - |
dc.format.extent | 2371~2382 | - |
dc.relation.isPartOf | LANCET | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/2.0/kr/ | - |
dc.subject.MESH | Coronary Artery Disease/mortality* | - |
dc.subject.MESH | Coronary Artery Disease/therapy* | - |
dc.subject.MESH | Drug Therapy, Combination | - |
dc.subject.MESH | Drug-Eluting Stents* | - |
dc.subject.MESH | Hemorrhage/epidemiology | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Myocardial Infarction/epidemiology | - |
dc.subject.MESH | Myocardial Infarction/prevention & control | - |
dc.subject.MESH | Platelet Aggregation Inhibitors/administration & dosage* | - |
dc.subject.MESH | Platelet Aggregation Inhibitors/adverse effects* | - |
dc.subject.MESH | Randomized Controlled Trials as Topic | - |
dc.subject.MESH | Thrombosis/epidemiology | - |
dc.subject.MESH | Thrombosis/prevention & control | - |
dc.subject.MESH | Time Factors | - |
dc.title | Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Internal Medicine (내과학) | - |
dc.contributor.googleauthor | Tullio Palmerini | - |
dc.contributor.googleauthor | Umberto Benedetto | - |
dc.contributor.googleauthor | Letizia Bacchi-Reggiani | - |
dc.contributor.googleauthor | Diego Della Riva | - |
dc.contributor.googleauthor | Giuseppe Biondi-Zoccai | - |
dc.contributor.googleauthor | Fausto Feres | - |
dc.contributor.googleauthor | Alexandre Abizaid | - |
dc.contributor.googleauthor | Myeong-Ki Hong ' | - |
dc.contributor.googleauthor | Byeong-Keuk Kim | - |
dc.contributor.googleauthor | Yangsoo Jang | - |
dc.contributor.googleauthor | Hyo-Soo Kim | - |
dc.contributor.googleauthor | Kyung Woo Park | - |
dc.contributor.googleauthor | Philippe Genereux | - |
dc.contributor.googleauthor | Deepak L Bhatt | - |
dc.contributor.googleauthor | Carlotta Orlandi | - |
dc.contributor.googleauthor | Stefano De Servi | - |
dc.contributor.googleauthor | Mario Petrou | - |
dc.contributor.googleauthor | Claudio Rapezzi | - |
dc.contributor.googleauthor | Dr Gregg W Stone | - |
dc.identifier.doi | 10.1016/S0140-6736(15)60263-X | - |
dc.admin.author | false | - |
dc.admin.mapping | false | - |
dc.contributor.localId | A00493 | - |
dc.contributor.localId | A03448 | - |
dc.contributor.localId | A04391 | - |
dc.relation.journalcode | J02152 | - |
dc.identifier.eissn | 1474-547X | - |
dc.identifier.pmid | 25777667 | - |
dc.identifier.url | http://www.sciencedirect.com/science/article/pii/S014067361560263X | - |
dc.subject.keyword | randomised clinical trial | - |
dc.subject.keyword | drug-eluting stent | - |
dc.subject.keyword | dual antiplatelet therapy | - |
dc.subject.keyword | clopidogrel | - |
dc.subject.keyword | aspirin | - |
dc.subject.keyword | thienopyridine | - |
dc.contributor.alternativeName | Kim, Byeong Keuk | - |
dc.contributor.alternativeName | Jang, Yang Soo | - |
dc.contributor.alternativeName | Hong, Myeong Ki | - |
dc.contributor.affiliatedAuthor | Kim, Byeong Keuk | - |
dc.contributor.affiliatedAuthor | Jang, Yang Soo | - |
dc.contributor.affiliatedAuthor | Hong, Myeong Ki | - |
dc.rights.accessRights | not free | - |
dc.citation.volume | 385 | - |
dc.citation.number | 9985 | - |
dc.citation.startPage | 2371 | - |
dc.citation.endPage | 2382 | - |
dc.identifier.bibliographicCitation | LANCET, Vol.385(9985) : 2371-2382, 2015 | - |
dc.identifier.rimsid | 29920 | - |
dc.type.rims | ART | - |
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