Comparison of short-term and long-term dual antiplatelet therapy after implantation of drug-eluting stents—Meta analysis
10.3969/j.issn.1006-0111.201907135
- VernacularTitle:植入药物洗脱支架后短期与长期双联抗血小板疗效比较的Meta分析
- Author:
Shuyang FEI
1
;
Li ZHAO
2
;
Lin SUN
2
;
Rong ZHANG
2
;
Jing LI
2
;
Changjiang GE
3
Author Information
1. Anzhen Hospital, Capital Medical University, Beijing 100048, China.
2. Sixth Medical Center of General Hospital of PLA, Beijing 100048, China.
3. Anzhen Hospital, Capital Medical University, Beijing 100048, China.cjge1116@163.com
- Keywords:
dual antiplatelet therapy;
drug eluting stents;
acute coronary syndrome;
stable angina;
randomized controlled trial;
Meta analysis
- From:
Journal of Pharmaceutical Practice
2020;38(1):81-87
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the clinical effects of short-term (3-6 months) and long-term (12 months) dual antiplatelet therapy (DAPT) after the implantation of coronary drug-eluting stents (DES). Methods The eligibilities of the patients included stable angina, acute coronary syndrome and silent ischemia. The lesions were in a native coronary vessel. The clinical observation endpoints were all-cause death, cardiogenic death, myocardial infarction, stroke, stent thrombosis, target lesion revascularization, severe bleeding, and true adverse clinical events. The clinical observation endpoints were all-cause death, cardiogenic death, myocardial infarction, stroke, stent thrombosis, target lesion revascularization, severe bleeding, and true adverse clinical events. By searching Pubmed, Chinese biomedical literature and other Chinese and English databases and manual search, qualified randomized controlled studies were evaluated and data were extracted for meta-analysis. Results A total of 12 randomized controlled studies were conducted. Detsky scores were all greater than 5 points. There were a total of 25949 patients in the study with a follow-up rate of 97.9%. There were no significantly different in all cause death (OR = 0.86，95%CI 0.71-1.05，P = 0.14), cardiac death (OR = 0.94，95% CI 0.70-1.25，P = 0.67), stent thrombosis (OR = 1.36，95%CI 0.94-1.98，P = 0.11), stroke (OR = 1.01，95%CI 0.71-1.42，P = 0.98), target lesion revascularization (OR = 0.121，95%CI 0.94-1.55，P = 0.14),and true adverse clinical events (OR = 0.98，95%CI 0.83-1.14，P = 0.75). The incident rate of myocardial infarction during the follow-up period was higher in the short-term group than in the long-term group (OR = 1.27, 95% CI 1.02-1.59, P = 0.04). The proportion of severe bleeding in the long-term group increased significantly (OR = 0.69, 95% CI 0.50-0.95, P = 0.02). Asian population studies showed that all-cause mortality was higher in the long-term treatment group than in the short-term group (OR = 0.72, 95% CI 0.53-0.97, P = 0.03), and there was no significant difference in severe bleeding between the two groups. Conclusion According to the defined clinical observation endpoints, the short-term dual antiplatelet effect is not inferior to the long-term group. Seven asian group studies have shown that the long-term group has high all-cause mortality. It can not rule out the deviation and/or population caused by the small sample size or individual variation. The results need to be further verified. This result can be used as a clinical warning to adjust the dual antiplatelet cycle based on the individualized risk of bleeding and coronary lesions.
