Meta Analysis Of Dual Antiplatelet Therapy ≤3 Months And Dual Antiplatelet Therapy 12-Months After Second-generation Drug-eluting Stents Implantation

Objective: To systematically review of the safety and effectiveness of dual antiplatelet therapy(DAPT)with very short-term(≤3 months)and standard duration(12 months)after second-generation drug-eluting stents(DES)implantation.Methods: We systematically searched the Pub Med,Cochrane Library,and E MBASE databases to collect relevant studies on different duration of DAPT after the new-generation DES implantation from inception to October 2019.The clinical end points were all-cause death,cardiac death,myocardial infarc tion(MI),stent thrombosis(ST),stroke,major bleeding,and all bleeding ev ent.Qualified randomized controlled trials(RCTs)were evaluated and data were extracted.The meta analysis was performed with Rev Man5.3 software.Results: Six RCTs meeting the criteria were included,with a total of 28669 patients,including 14326 cases in the very short-term DAPT group(1-3 months)and 14343 in the standard 12 months DAPT group.DAPT for 3 months was investigated in four studies,while DAPT for 1 month was investigated in the other two.Pooled analysis demonstrated that,in terms of survival endpoints,there was no significant difference in all-cause mortality [OR=0.95,95%CI(0.79,1.15),P=0.60],cardiac death [OR=0.97,95%CI(0.67,1.39),P=0.85] with ≤3 months DAPT vs 12 months DAPT.Moreover,there was no significant difference in ischemic outcomes,including MI [OR=1.10,95% CI(0.93,1.32),P=0.26],ST [OR=1.03,95% CI(0.76,1.39),P=0.87],and stroke [OR =1.00,95%CI(0.74,1.36),P=0.99] between the two groups.Compared with 12 months DAPT group,≤3 months DAPT group was associated with lower clinically major bleeding [OR=0.78,95%CI(0.63,0.96),P=0.02] and all bleeding [OR=0.58,95%CI(0.43,0.77),P=0.0002).Conclusion: Compared with the standard 12 months DAPT,≤3 months DAP T was effective in reducing the risk of bleeding,and there was no significa nt difference in prevention of ischemic cardiocerebrovascular events between the two groups after second-generation DES implantation,i.e.for middle and low-risk patients with coronary heart disease,≤3 months DAPT is not infer ior to 12 months DAPT for patients implanted with the new-generation DES.