Efficacy And Safety Of Short-term (≤6 Months) Duration Of Dual Antiplatelet Therapy After Second Generation Drug Eluting Stents:a Meta-Analysis Of Randomized Controlled Trials

Background:The optimal duration of dual antiplatelet therapy (DAPT) after drug eluting stent (DES) implantation remains controversial. We aimed to assess the efficacy and safety of short-term (≤6 months) DAPT after DES implantation in patients with coronary artery disease, especially in important subgroups.Methods:We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCT) comparing short-term and long-term (≥ 12 months) DAPT after second generation DES implantation. The primary efficacy outcome was stent thrombosis. The primary safety outcome was major bleeding. We calculated pooled relative risks (RRs) and 95% Cis using random-or fixed-effect models when appropriate.Results:We included 7 RCTs involving 15870 patients. Short-term DAPT significantly reduced major bleeding by 49% compared with long-term DAPT (RR:0.51; 95% CI:0.32-0.80; P=0.003) without increasing the risk of stent thrombosis (RR:1.28; 95% CI:0.83-1.97; P=0.266). Moreover, no differences were observed in the all-cause mortality, myocardial infarction, cardiac mortality, cerebrovascular accidents. Besides, no significant difference in composite of cardiovascular events, bleeding, and mortality was found in important clinical subgroups:age (year< 65 or≥65 years), sex, history of diabetes, renal function (creatinine clearance< 60 mL/min or>60 mL/min), left ventricular (LV) ejection fraction (< 50% or≥50%), acute coronary syndrome (ACS)/unstable coronary disease, bifurcation, multi-stent, simple or complex lesion(s).Conclusions:Short-term DAPT after second generation DES implantation is associated with lower bleeding risk compared with long-term DAPT, without increasing the risk of stent thrombosis, all-cause mortality, myocardial infarction, cardiac mortality, and cerebrovascular accidents.