Skip to main content
SpringerLink
Log in

Safety and Efficacy of Short-Term vs. Standard Periods Dual Antiplatelet Therapy After New-Generation Drug-Eluting Stent Implantation: A Meta-analysis

  • Conference paper
  • First Online:
Intelligent Computing Theories and Application (ICIC 2022)

Part of the book series: Lecture Notes in Computer Science ((LNCS,volume 13393))

Included in the following conference series:

  • 1498 Accesses

Abstract

To evaluate the safety and efficacy of short-term (6 months) and standard period (12 months) dual antiplatelet therapy (DAPT) after using a new generation of eluting drug stent (DES) in patients with coronary artery disease. Systematic review and meta-analysis were performed by searching PubMed, Embase, and Cochrane library databases for randomized controlled trials reporting on short-term (<6 months) and standard (12 months) DAPT after percutaneous coronary intervention implantation of a new-generation DES from inception to December 2020. The safety and effectiveness of treatment were compared. The primary endpoints were myocardial infarction, stent thrombosis, and major bleeding; secondary endpoints were all-cause mortality, cardiogenic death, any bleeding, stroke, target vessel revascularization, and net adverse clinical events. Sixteen studies (total 53,861 patients) were included. The incidence of major bleeding and any bleeding event in the short-term group was lower compared to standard-period group (major bleeding: 0.99% vs. 1.42%, RR = 0.68, 95%CI 0.57–0.82; major bleeding: 2.16% vs 3.19%, RR = 0.68, 95%CI 0.58–0.79; all P < 0.001), while there was no difference in myocardial infarction (2.16% vs 2.06%, RR = 1.04, 95%CI 0.93–1.17, P = 0.46), stent thrombosis (0.48% vs 0.38%, RR = 1.24, 95%CI 0.90–1.70, P = 0.20), all-cause mortality (1.70% vs 1.88%, RR = 0.90, 95%CI 0.80–1.02, P = 0.01), cardiogenic death (1.79% vs 0.97%, RR = 0.81, 95%CI 0.65–1.02, P = 0.08), stroke (0.72% vs 0.74%, RR = 0.96, 95%CI 0.78–1.19, P = 0.72), target vessel revascularization (3.87% vs 4.02%, RR = 0.99, 95%CI 0.87–1.12, P = 0.82), and net adverse clinical events (4.55% vs 5.01%, RR = 0.91, 95%CI 0.81–1.02, P = 0.09). Short-term DAPT significantly reduces the risk of bleeding compared with standard DAPT after percutaneous coronary intervention with a new-generation DES, without increasing the risk of mortality or ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Liberati, A., Altman, D.G., Tetzlaff, J., et al.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339(jul21 1), b2700–b2700 (2009). https://doi.org/10.1136/bmj.b2700

    Article  Google Scholar 

  2. Cutlip, D.E., Windecker, S., Mehran, R., et al.: Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115(17), 2344–2351 (2007)

    Google Scholar 

  3. Higgins, J.P.T., Altman, D.G., Gotzsche, P.C., et al.: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343(oct18 2), d5928–d5928 (2011). https://doi.org/10.1136/bmj.d5928

    Article  Google Scholar 

  4. Higgins, J., Thompson, S.G., Decks, J.J., et al.: Measuring inconsistency in meta-analyses. BMJ 327(7414), 557–560 (2003)

    Article  Google Scholar 

  5. Collet, J., Silvain, J., Barthélémy, O., et al.: Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): a randomised trial. Lancet 384(9954), 1577–1585 (2014)

    Article  Google Scholar 

  6. Physicians, A., O'Gara, P.T., Kushner, F.G., et al.: ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. College Cardiol. 61(4), e78–e140 (2013)

    Google Scholar 

  7. Whan, L.C., Jung-Min, A., Duk-Woo, P., et al.: Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a randomized, controlled trial. Circulation 129(3), 304–312 (2014)

    Google Scholar 

  8. Kedhi, E., Fabris, E., van der Ent, M., et al.: Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial. BMJ 363, k3793 (2018)

    Article  Google Scholar 

  9. Gwon, H.C., Hahn, J.Y., Park, K.W., et al.: Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) randomized, multicenter study. Circulation 125(3), 505–513 (2012)

    Google Scholar 

  10. Pascal, V., Marco, V., Peter, J., et al.: Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet (London, England) 392(10151), 940–949 (2018)

    Google Scholar 

  11. Han, Y., Xu, B., Xu, K., et al.: Six Versus 12 months of dual antiplatelet therapy after implantation of biodegradable polymer sirolimus-eluting stent: randomized substudy of the I-LOVE-IT 2 Trial. Circ. Cardiovasc. Interv. 66(2), B38–B38 (2015)

    MathSciNet  Google Scholar 

  12. Schulz-Schupke, S., Byrne, R.A., Berg, J.M., et al.: ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Euro. Heart J. 36(20), 1252–1263 (2015). https://doi.org/10.1093/eurheartj/ehu523

    Article  Google Scholar 

  13. Hong, S.J., Shin, D.H., Kim, J.S., et al.: 6-month versus 12-month dual-antiplatelet therapy following long everolimus-eluting stent implantation. JACC: Cardiovas. Intervent. 9(14), 1438–1446 (2016). https://doi.org/10.1016/j.jcin.2016.04.036

  14. Feres, F., Costa, R.A., Abizaid, A., et al.: Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA 310(23), 2510–2522 (2013)

    Google Scholar 

  15. Luca, G.D., Damen, S.A., Camaro, C., et al.: Final results of the randomised evaluation of short-term dual antiplatelet therapy in patients with acute coronary syndrome treated with a new-generation stent (REDUCE trial). EuroIntervent. J. EuroPCR Collabor. Work. Group Intervent. Cardiol. Euro. Soc. Cardiol. 15(11), e990–e998 (2019)

    Google Scholar 

  16. Byeong-Keuk, K., Myeong-Ki, H., Dong-Ho, S., et al.: A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J. Am. College Cardiol. 60(15), 1340–1348 (2012)

    Google Scholar 

  17. Byoung-Kwon, L., Jung-Sun, K., Oh-Huyn, L., et al.: Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C Randomised Clinical Trial and OCT Substudy. EuroIntervent. J. EuroPCR Collabor. Work. Group Intervent. Cardiol. Euro. Soc. Cardiol. 13(16), 1923–1930 (2018)

    Google Scholar 

  18. Yong, H.J., Bin, S.Y., Hyeon, O.J., et al.: Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: the SMART-CHOICE randomized clinical trial. JAMA 321(24), 2428–2437 (2019)

    Article  Google Scholar 

  19. Hahn, J., Song, Y.B., Oh, J., et al.: 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial. The Lancet 391(10127), 1274–1284 (2018)

    Article  Google Scholar 

  20. Hirotoshi, W., Takenori, D., Takeshi, M., et al.: Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA 321(24), 2414–2427 (2019)

    Article  Google Scholar 

  21. Kim, B., Hong, S., Cho, Y., et al.: Effect of ticagrelor monotherapy vs ticagrelor with aspirin on major bleeding and cardiovascular events in patients with acute coronary syndrome: the TICO randomized clinical trial. JAMA 323(23), 2407–2416 (2020)

    Article  Google Scholar 

  22. Mehran, R., Baber, U., Sharma, S.K., et al.: Ticagrelor with or without aspirin in high-risk patients after PCI. N. Engl. J. Med. 381(21), 2032–2042 (2019)

    Article  Google Scholar 

  23. Colombo, A., Chieffo, A., Frasheri, A., et al.: Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial. J. Am. College Cardiol. 64(20), 2086–2097 (2014)

    Google Scholar 

  24. Roth, G.A., Johnson, C., Abajobir, A., et al.: Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J. Am. Coll. Cardiol. 70(1), 1–25 (2017)

    Article  Google Scholar 

  25. Costa, F., Klaveren, D.V., James, S., et al.: Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389(10073), 1025–1034 (2017)

    Article  Google Scholar 

  26. Arbel, Y., Bennell, M.C., Goodman, S.G., et al.: Cost-effectiveness of different durations of dual-antiplatelet use after percutaneous coronary intervention. Can. J. Cardiol. 34(1), 31 (2018)

    Article  Google Scholar 

  27. Mehran, R., Baber, U., Steg, P.G., et al.: Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 382(9906), 1714–1722 (2013)

    Google Scholar 

  28. Rao, S.V., Grady, K.O., Pieper, K.S., et al.: A comparison of the clinical impact of bleeding measured by two different classifications among patients with acute coronary syndromes. J. Am. Coll. Cardiol. 47(4), 809–816 (2006)

    Article  Google Scholar 

  29. Budaj, A., Eikelboom, J.W., Mehta, S.R., et al.: Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur. Heart J. 30(6), 655–661 (2008)

    Article  Google Scholar 

  30. Palmerini, T., Benedetto, U., Bacchi-Reggiani, L., et al.: Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. Lancet 385(9985), 2371–2382 (2015)

    Article  Google Scholar 

  31. Bittl, J.A., Baber, U., Bradley, S.M., et al.: Duration of dual antiplatelet therapy: a systematic review for the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Associ. J. Am. College Cardiol. 2016, 1116–1139 (2016)

    Google Scholar 

  32. Mauri, L., Kereiakes, D.J., Yeh, R.W., et al.: Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. South China J. Cardiol. 371(4), 2155–2166 (2014)

    Google Scholar 

  33. Dangas, G.D., Serruys, P.W., Kereiakes, D.J., et al.: Meta-analysis of everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. JACC: Cardiovasc. Intervent. 6(9), 914–922 (2013)

    Google Scholar 

  34. De Luca, G., Smits, P., Hofma, S.H., et al.: Everolimus eluting stent vs first generation drug-eluting stent in primary angioplasty: a pooled patient-level meta-analysis of randomized trials. Int. J. Cardiol. 244, 121–127 (2017)

    Article  Google Scholar 

  35. Tullio, P., Diego, D.R., Umberto, B., et al.: Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. Eur. Heart J. 14, 1034–1043 (2017)

    Google Scholar 

  36. Misumida, N., Abo-Aly, M., Kim, S.M., et al.: Efficacy and safety of short-term dual antiplatelet therapy (≤6 months) after percutaneous coronary intervention for acute coronary syndrome: a systematic review and meta-analysis of randomized controlled trials. Clin. Cardiol. 41(11), 1455–1462 (2018)

    Article  Google Scholar 

  37. Mauri, L., Kereiakes, D.J., Yeh, R.W., et al.: Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. South China J. Cardiol 371, 2155–2166 (2014)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China

    Xiaohua Gao & Meili Cheng

  2. Changzhi Medical College, Changzhi, 046000, China

    Xiaodan Bi & Jinpeng Yang

Authors
  1. Xiaohua Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaodan Bi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jinpeng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Meili Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meili Cheng .

Editor information

Editors and Affiliations

  1. Tongji University, Shanghai, China

    De-Shuang Huang

  2. University of Ulsan, Ulsan, Korea (Republic of)

    Kang-Hyun Jo

  3. Xi'an Polytechnic University, Xi'an, China

    Junfeng Jing

  4. The University of Wollongong, North Wollongong, NSW, Australia

    Prashan Premaratne

  5. Polytecnic of Bari, Bari, Italy

    Vitoantonio Bevilacqua

  6. Liverpool John Moores University, Liverpool, UK

    Abir Hussain

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Gao, X., Bi, X., Yang, J., Cheng, M. (2022). Safety and Efficacy of Short-Term vs. Standard Periods Dual Antiplatelet Therapy After New-Generation Drug-Eluting Stent Implantation: A Meta-analysis. In: Huang, DS., Jo, KH., Jing, J., Premaratne, P., Bevilacqua, V., Hussain, A. (eds) Intelligent Computing Theories and Application. ICIC 2022. Lecture Notes in Computer Science, vol 13393. Springer, Cham. https://doi.org/10.1007/978-3-031-13870-6_58

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-13870-6_58

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-13869-0

  • Online ISBN: 978-3-031-13870-6

  • eBook Packages: Computer ScienceComputer Science (R0)

Publish with us

Policies and ethics

Search

Navigation