Duration Of Dual Antiplatelet Therapy After Second-genenration Drug-eluting Stent Implantation In Patients With Diabetes Mellitus

Background: Diabetes mellitus(DM)was considered to be one of the independent risk factor for thromboembolic events,but the optimal duration of dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI)in these patients remained controversial.The purpose of this study was to evaluate the safety and efficacy of short-term and long-term DAPT after second-generation drug-eluting stents(DES)implantation in patients with DM.Methods: We searched Pubmed,Embase,Cochrane Library,Wanfang Data,CNKI and relevant Web sites(www.Clinical Trials.gov)up to December 2019 to perform analysis of short-term(≤ 6 months)versus long-term(≥ 12 months)DAPT in DM patients that implanted with second-generation DES.The primary efficacy endpoint was definite / probable stent thrombosis(ST),the primary safety endpoint was major bleeding event,and the secondary endpoints were myocardial infarction(MI),target vessel recanalization(TVR),all-cause mortality and stroke.All dete were statistically analyzed using Rev Man5.3 software.Results: Six randomized controlled trials were finally included,with a total of3667 patients with DM,1818 in the short-term DAPT group and 1849 in the long-term DAPT group.In terms of the primary efficacy endpoint,there was no significant difference between the two groups in definite/probable ST(OR 1.27,95%CI 0.48-3.31,P = 0.63).For the primary safety endpoint,there was no significant difference between the two groups in major bleeding event(OR 0.76,95% CI0.24-2.38,P = 0.63).Moreover,there was no significant difference in the secondary endpoints,including MI(OR 1.11,95% CI 0.73-1.63,P = 0.64),TVR(OR 0.95,95%CI 0.58-1.53,P = 0.82),all-cause mortality(OR 0.95,95% CI 0.58-1.53,P = 0.82)and stroke(OR 0.90,95% CI 0.34-2.34,P = 0.82).Conclusion: This study demonstrated that compared with long-term DAPT,short-term DAPT had no significant difference on the clinical outcomes of patients with DM implanted with second-generation DES.