Safety And Efficacy Of Short Term Versus Long Term Dual Anti-platelet Therapy After Second Generation Drug Eluting Stent Therapy: A Meta-analysis

Background: The safety and efficacy of short term dual anti platelet therapy insecond generation drug eluting stent remain unknown.Method: We searched Embase, Pubmed, Google scholar articles, CochraneLibrary and Chinese Literature database up to February2014to performanalysis of short term dual antiplatelet against long term dual antiplatelettherapy in second generation drug eluting stent implantation. Our analysisconsists of7562patients with4041patients grouped to short term (≤6months)and3521patients grouped to long term (>6months) dual anti-platelet therapy infour randomized trials and two non-randomized trials. All patients in ouranalysis were implanted only with second generation drug eluting stents thatinclude Zotarolimus Eluting Stent and Everolimus Eluting Stent types. Tworeviewers independently extracted the data and checked the quality evaluation ofeach study and after that, cross checked each other. The systemic evaluation forthis study was cited by the Cochrane RevMan5.1software. The median duration dual anti-platelet therapy for short term and long term group were4and12.9months respectively.Result: The primary endpoint was major adverse cardiac events (MACE) andsecondary endpoints were in detail of the primary end point (Death, MyocardialInfarct, Target vessel revascularization), stent thrombosis (Definite or Probable)and major or minor Bleeding. At follow up, short term DAPT in PCI withsecond generation drug eluting stent did not increase in MACE (OR=0.05,95%CI=0.84–1.30, P=0.67)，Myocardial Infarct (OR=1.03,95%CI=0.65-1.64,P:0.9), Death (OR=0.86,95%CI=0.61-1.23, P:0.41), Target VesselRevascularization (OR=1.13,95%CI=0.87-1.47, P:0.37), and StentThrombosis(OR=1.12,95%CI=0.47-2.67, P:0.8). But decreased in major orminor bleeding (OR=0.32,95%CI=0.17-0.59, P:0.0003).Conclusion: This is the first analysis which analyzes the safety and efficacy ofshort and long term dual antiplatelet therapy on second generation drug elutingstent. The result showed that short term dual anti-platelet therapy in PCI withsecond generation drug eluting stent reduce the risk of bleeding without increasein major adverse cardiovascular events. So, Short term dual anti-platelet therapymay be feasible in PCI with second generation drug eluting stent especially inpatients with high risk of bleeding, elderly patients with poor compliance topost-operative medication, patients with low risk of thrombosis andpost-operative PCI with possibility of non-cardiac surgery. However, futurelarge multi-center, prospective randomized trials are required to confirm theeffect of short term dual anti-platelet therapy on specific stent type.