Shorter DAPT Duration Linked to Most Favorable Net Clinical Outcomes After PCI

Shorter-term dual antiplatelet therapy (DAPT), lasting 1 to 3 months following coronary stenting, was found during a systematic review and meta-analysis to be more effective than longer-term therapy. These findings were presented during the American College of Cardiology annual meeting held virtually May 15-17, 2021.

The medical publication databases PubMed, Scopus, and Cochrane Central were searched for studies of DAPT after coronary stenting by researchers from Emory University and the University of Miami, who noted in their study abstract that “the optimal [DAPT] duration after percutaneous coronary intervention…to balance thrombotic and bleeding risks is not entirely understood.”

The authors evaluated a total of 14 randomized clinical trials comprising 50,552 patients. Mean age of the patients was 64 years, and about half had acute coronary syndrome. The patients were followed for 12 months.

All-cause mortality was reported for 808 of the 40,401 patients who had received DAPT either 1-3 months or 12 months after stenting, and major bleeding events occurred among 728 of the 40,401 patients. Among the 37,381 patients who received DAPT at 3 months or 12 months, there were 1599 major adverse cardiovascular events.

When patients were stratified by 1-3 month DAPT or 12-month DAPT after coronary stenting, the risk for all-cause mortality was decreased among those who received the shorter-term therapies (378 vs 430; odds ratio [OR], 0.88; 95% CI, 0.76-1.01). The risk for major bleeding events was also decreased with shorter-term DAPT (308 vs 420; OR, 0.64; 95% CI, 0.48-0.85). No significant difference between shorter- vs longer-term DAPT was observed for major adverse cardiovascular event risk (778 vs 821, respectively; OR, 0.97; 95% CI, 0.85-1.10).

No evidence of study heterogeneity was detected for the analyses of all-cause mortality (c², 3.48; degrees of freedom [df], 7; P =.84; I², 0%) or major adverse cardiovascular events (c², 7.71; df, 6; P =.26; I², 22%). There was significant heterogeneity identified among the underlying data for the assessment of major bleeding (c², 16.87; df, 7; P =.02; I², 59%).

This meta-analysis may have been limited by the significant heterogeneity of the studies included and the evaluation of combined data collected on patients with different cardiovascular diseases. It remains unclear whether longer-term DAPT may be appropriate for a subset of patients.

The investigators concluded that the study data suggest shorter-term DAPT following coronary stenting may decrease the risk for all-cause mortality and major bleeding events without increasing the risk for major adverse cardiovascular events.

Reference

Knijnik LM, Fernandes M, Cardoso R, et al. Dual antiplatelet therapy for 1 to 3 months is superior to 12 months after coronary stenting. Presented at: ACC.21 Annual Meeting May 15-17, 2021.