Efficacy And Safety Of Short-term Dual Antiplatelet Therapy After New-generation Drug-eluting Stents Implantation In East Asians: A Systematic Review And A Meta-analysis Of Randomized Clinical Trials

Background and objectives: Dual antiplatelet therapy（DAPT）is the mainstay regimen to prevent the recurrent ischemic events after percutaneous coronary intervention.The efficacy and safety of short-term DAPT after percutaneous coronary intervention has been confirmed by a series of studies.However,due to the ethnic differences,the risk of bleeding is higher and the risk of ischemia is lower in East Asians.Meanwhile,the emergence of new-generation drug-eluting stents makes it possible to shorten the duration of DAPT.The optimal duration of DAPT for patients implanted with new-generation drug-eluting stents in East Asian is currently still controversial.The purpose of this meta-analysis was to investigate the efficacy and safety of short-term DAPT in patients with those.Methods: Pub Med,Cochrane Library,EMBASE english literature databases,and Weipu,Wanfang,CNKI（China National Knowledge Infrastructure）medical literature database were systematically searched from inception to September 2020.Meanwhile,watched the European Society of Cardiology,American College of Cardiology,American Heart Association,2020 Northeast Cardiovascular Disease Online Forum conferences.Randomized controlled trials were included to compare the efficacy and safety of short-term（6-month or less）with long-term（12-month or more）DAPT.The patients were limited to East Asian implanted with new-generation drug-eluting stents.The intervention was a short-term（6-month or less）DAPT strategy,the control group used a long-term（12-month or more）DAPT strategy.The primary efficacy outcome was all-cause death,the primary safety outcome was major bleeding,and the secondary outcomes included cardiovascular death,myocardial infarction,definite or possible stent thrombosis,and stroke.The inclusion criteria are as follows:（a）the East Asian patients;（b）compared short-term DAPT strategy（6-month or less）with long-term DAPT strategy（12-month or more）;（c）The included trials should include the outcomes of interest to us;（d）randomized controlled trials;（e）the new-generation drug-eluting stent was applied to the patients;（f）follow-up duration≥12 months.The exclusion criteria are as follows:（a）less than 90% of patients had follow-up data;（b）ongoing research;（c）the full-text is not available.The risk ratio（RR）and 95% confidence interval（CI）for outcome was calculated by the fixed effects model.The Trial Sequence Analysis（TSA）was used to assess the anticipated sample size and evaluate the results.Meanwhile,the risk of bias for each randomized controlled trial was performed according to the Cochrane Collaboration risk-of-bias-tool 2.The Grades of Recommendations Assessment,Development and Evaluation（GRADE）was applied to evaluate the certainty of evidence for each outcome.Results: Six randomized controlled trials with 15688 patients were eligible for this meta-analysis,there were no significant differences in the incidence of all-cause death（RR 1.03,0.76–1.39,P=0.856）,cardiovascular death（RR 0.83,0.55-1.24,P=0.361）,myocardial infarction（RR 0.97,0.72-1.31,P=0.853）,definite or possible stent thrombosis（RR 1.52,0.83-2.78,P=0.170）,and stroke（RR 0.90,0.61-1.31,P=0.574）between short-term and long-term DAPT.However,the significant difference in the risk of major bleeding（RR 0.64,0.49-0.85,P=0.002）was observed between the two groups.Conclusions: Compared with long-term DAPT,the short-term DAPT can reduce the risk of major bleeding in East Asian implanted with new-generation drug-eluting stents without increasing the risk of death or ischemia.The population included in this meta-analysis was patients implanted with new-generation drug-eluting stents in East Asian.Therefore,the result is difficult to apply to other patients（Registered by PROSPERO,CRD 42020213266）.