Meta-analysis Of Short Versus Long Term Dual Antiplatelet Therapy After Second-generation Drug-eluting Stents Implantation

Purpose:we aim to evaluate the efficacy and safety of the short-term(≤6months)and long-term(≥12 months)dual antiplatelet therapy(DAPT)after second-generation drug-eluting stents(DES)implantation.Methods:We searched studies from Pubmed,Embase,the Cochrane library,Medline,Sciencedirect and Springer database in the English language,and CBM,CNKI,VIP and WANFANG database in Chinese language.The retrieval time was limited from January 1,2000 to March 20,2018.Treatment was divided into ≤6 months group and ≥12 months group.Statistical analyses was performed by using the random effect model.We also made the subgroup analysis for patients with ACS,and the comparison of DAPT ≤6 months group with 12 months group and ≥18 months group.The endpoints included all cause mortality,cardiac death,non cardiac death,myocardial infarction(MI),stentthrombosis(ST),stroke,all bleeding and major bleeding.Results: nine randomised controlled trials with 17683 patients were included in this study.8822 patients in the short term DAPT group,and 8861 patients in the long term DAPT group.In term of efficacy,there was no significant difference in all causes mortality(HR=0.89,95%CI 0.72~1.10,P=0.27),cardiac death(HR=0.88,95%CI 0.66~1.16,P=0.36),and non-cardiac death(HR=0.90,95%CI 0.66~1.23,P=0.52)in two groups.Moreover,there was no significant difference in MI(HR=1.24,95%CI 0.99~1.54,P=0.06),ST(HR=1.18,95%CI 0.83~1.68,P=0.36),and stroke(HR=0.94,95%CI0.66~1.34,P=0.73)in two groups.In term of safety,there was no significant difference in all bleeding(HR=0.81,95%CI 0.64~1.04,P=0.10)and major bleeding(HR=0.80,95%CI 0.55~1.16,P=0.23).Subgroup analysis showed that in term of efficacy and safety,there were no significant difference in patients with acute coronary syndrome(ACS)and the comparison of DAPT ≤6 months group with 12 months group and ≥18 months group.Conclusion: short-term DAPT is non-inferior to long-term DAPT in patients implanted with the second-generation DES.