BACKGROUND: Patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are at increased risk for subsequent ischemic events. HYPOTHESIS: Short-term dual antiplatelet therapy (DAPT) (≤6 months) is inferior to standard or long-term DAPT in patients who undergo PCI for ACS events. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials that compared short-term (≤6 months) to long-term (≥12 months) DAPT after PCI for ACS. We searched MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials database. RESULTS: Ten randomized controlled trials, including a total of 12 696 patients, met our inclusion criteria. For short-term DAPT, duration of therapy ranged from 3 to 6 months, while long-term DAPT ranged from 12 to 24 months. The majority of studies used clopidogrel and second-generation drug-eluting stents. No statistically significant difference was found between short-term and long-term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94-1.57; P = 0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00-2.38; P = 0.052), or major bleeding events (odds ratio 0.74; 95% confidence interval 0.49-1.11; P = 0.14). There was no significant difference in all-cause mortality, cardiac death, or net adverse cardiac and cerebrovascular events. CONCLUSIONS: Our meta-analysis demonstrated that short-term DAPT (<6 months) after PCI for ACS was not associated with increased risk of myocardial infarction or stent thrombosis when compared to long-term DAPT.
BACKGROUND:Patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are at increased risk for subsequent ischemic events. HYPOTHESIS: Short-term dual antiplatelet therapy (DAPT) (≤6 months) is inferior to standard or long-term DAPT in patients who undergo PCI for ACS events. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials that compared short-term (≤6 months) to long-term (≥12 months) DAPT after PCI for ACS. We searched MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials database. RESULTS: Ten randomized controlled trials, including a total of 12 696 patients, met our inclusion criteria. For short-term DAPT, duration of therapy ranged from 3 to 6 months, while long-term DAPT ranged from 12 to 24 months. The majority of studies used clopidogrel and second-generation drug-eluting stents. No statistically significant difference was found between short-term and long-term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94-1.57; P = 0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00-2.38; P = 0.052), or major bleeding events (odds ratio 0.74; 95% confidence interval 0.49-1.11; P = 0.14). There was no significant difference in all-cause mortality, cardiac death, or net adverse cardiac and cerebrovascular events. CONCLUSIONS: Our meta-analysis demonstrated that short-term DAPT (<6 months) after PCI for ACS was not associated with increased risk of myocardial infarction or stent thrombosis when compared to long-term DAPT.
Authors: Laura Mauri; Dean J Kereiakes; Robert W Yeh; Priscilla Driscoll-Shempp; Donald E Cutlip; P Gabriel Steg; Sharon-Lise T Normand; Eugene Braunwald; Stephen D Wiviott; David J Cohen; David R Holmes; Mitchell W Krucoff; James Hermiller; Harold L Dauerman; Daniel I Simon; David E Kandzari; Kirk N Garratt; David P Lee; Thomas K Pow; Peter Ver Lee; Michael J Rinaldi; Joseph M Massaro Journal: N Engl J Med Date: 2014-11-16 Impact factor: 91.245
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Authors: Lars Wallentin; Richard C Becker; Andrzej Budaj; Christopher P Cannon; Håkan Emanuelsson; Claes Held; Jay Horrow; Steen Husted; Stefan James; Hugo Katus; Kenneth W Mahaffey; Benjamin M Scirica; Allan Skene; Philippe Gabriel Steg; Robert F Storey; Robert A Harrington; Anneli Freij; Mona Thorsén Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Neville Kukreja; Yoshinobu Onuma; Hector M Garcia-Garcia; Joost Daemen; Ron van Domburg; Patrick W Serruys Journal: JACC Cardiovasc Interv Date: 2009-06 Impact factor: 11.195
Authors: Julian P T Higgins; Douglas G Altman; Peter C Gøtzsche; Peter Jüni; David Moher; Andrew D Oxman; Jelena Savovic; Kenneth F Schulz; Laura Weeks; Jonathan A C Sterne Journal: BMJ Date: 2011-10-18
Authors: Firas R Al-Obaidi; Hayley A Hutchings; Andy S C Yong; Laith Alrubaiy; Hasan Al-Farhan; Mohammed H Al-Ali; Tahsin Al-Kinani; Mohammed Al-Myahi; Hussein Al-Kenzawi; Nazar Al-Sudani Journal: Curr Cardiol Rev Date: 2021