Efficacy And Safety Of Different Durations Of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention:A Meta-Analysis

Objective: To evaluate efficacy and safety of different durations of dual antiplatelet therapy(DAPT)after percutaneous coronary intervention.Methods: Literatures were searched in the Chinese and English database according to the specified retrieval strategy.The retrieved literatures searched from the database were within a period from the date of the database being built to December 2019.Literatures were selected according to inclusion criteria and exclusion criteria and divided into four groups according to the durations of DAPT: ultra-short-term(DAPT≤3 months),short-term(DAPT3-6 months),standard(DAPT12 months),and prolonged group(DAPT>12 months).The control group was the standard duration DAPT,and the experimental group was the ultra-short-term,short-term and prolonged DAPT.Rev Man 5.3 was used for Meta-analysis.The endpoints were all-cause mortality,cardiac death,myocardial infarction(MI),definite and/or probable stent thrombosis(ST),stroke,major bleeding and net adverse clinical and cerebral events(NACCE).The effects were expressed by the relative risk(RR)and the 95% confidence interval(CI).Results: Finally,16 RCTS were included.No significant difference in all-cause mortality(RR=0.87,95%CI 0.73-1.03,P=0.11),MI(RR=0.91,95%CI 0.78-1.07,P=0.28),ST(RR=0.85,95%CI 0.65-1.10,P=0.22),stroke(RR=1.08,95%CI 0.81-1.46,P=0.59)and NACCE(RR=0.95,95%CI 0.79-1.14,P=0.55)was observed between ultra-short-term and standard duration DAPT.A ultra-short-term DAPT significantly reduced the incidence of cardiac death(RR=0.79,95%CI 0.64-0.97,P=0.03)and major bleeding events(RR=0.62,95%CI 0.40-0.97,P=0.04)compared with standard duration DAPT.No significant difference in all-cause mortality(RR=0.80,95%CI 0.59-1.08,P=0.14),cardiac death(RR=0.71,95%CI 0.46-1.12,P=0.14),MI(RR=1.29,95%CI 0.99-1.68,P=0.06),ST(RR=1.42,95%CI 0.90-2.24,P=0.13),stroke(RR=0.95,95%CI 0.63-1.41,P=0.79),major bleeding(RR=0.87,95%CI 0.54-1.42,P=0.58)and NACCE(RR=0.99,95%CI 0.83-1.17,P=0.90)was observed between short-term and standard duration DAPT.Moreover,there was no significant difference in all-cause mortality(RR=0.96,95%CI 0.58-1.57,P=0.86),cardiac death(RR=0.89,95%CI 0.62-1.28,P=0.52),ST(RR=0.46,95%CI 0.10-2.07,P=0.31),stroke(RR=0.88,95%CI 0.59-1.29,P=0.50),major bleeding(RR=1.42,95%CI 0.95-2.11,P=0.08)and NACCE(RR=0.87,95%CI 0.63-1.18,P=0.36)between prolonged and standard duration DAPT.A prolonged DAPT significantly decreased the incidence of MI(RR=0.53,95%CI 0.42-0.65,P<0.00001)compared with standard DAPT.Conclusions: The efficacy and safety of shortened duration DAPT are not inferior to that of standard duration DAPT,and the efficacy and safety of extended DAPT are also not inferior to that of standard duration DAPT.An individualized approach is needed,taking into account the individual basic diseases,angiographic characteristics,stent type,risks of ischemic and bleeding events,etc.