Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis

Tullio Palmerini, Diego Sangiorgi, Marco Valgimigli, Giuseppe Biondi-Zoccai, Fausto Feres, Alexandre Abizaid, Ricardo A. Costa, Myeong Ki Hong, Byeong Keuk Kim, Yangsoo Jang, Hyo Soo Kim, Kyung Woo Park, Andrea Mariani, Diego Della Riva, Philippe Genereux, Martin B. Leon, Deepak L. Bhatt, Umberto Bendetto, Claudio Rapezzi, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

Original languageEnglish (US)
Pages (from-to)1092-1102
Number of pages11
JournalJournal of the American College of Cardiology
Volume65
Issue number11
DOIs
StatePublished - Mar 24 2015
Externally publishedYes

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Drug-Eluting Stents
Therapeutics
Confidence Intervals
Hemorrhage
Network Meta-Analysis
Randomized Controlled Trials
MEDLINE
Stents
Thrombosis
Myocardial Infarction
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Sangiorgi, Diego ; Valgimigli, Marco ; Biondi-Zoccai, Giuseppe ; Feres, Fausto ; Abizaid, Alexandre ; Costa, Ricardo A. ; Hong, Myeong Ki ; Kim, Byeong Keuk ; Jang, Yangsoo ; Kim, Hyo Soo ; Park, Kyung Woo ; Mariani, Andrea ; Della Riva, Diego ; Genereux, Philippe ; Leon, Martin B. ; Bhatt, Deepak L. ; Bendetto, Umberto ; Rapezzi, Claudio ; Stone, Gregg W. / Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation : An individual patient data pairwise and network meta-analysis. In: Journal of the American College of Cardiology. 2015 ; Vol. 65, No. 11. pp. 1092-1102.
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title = "Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis",
abstract = "Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95{\%} confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95{\%} CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95{\%} CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95{\%} CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.",
author = "Tullio Palmerini and Diego Sangiorgi and Marco Valgimigli and Giuseppe Biondi-Zoccai and Fausto Feres and Alexandre Abizaid and Costa, {Ricardo A.} and Hong, {Myeong Ki} and Kim, {Byeong Keuk} and Yangsoo Jang and Kim, {Hyo Soo} and Park, {Kyung Woo} and Andrea Mariani and {Della Riva}, Diego and Philippe Genereux and Leon, {Martin B.} and Bhatt, {Deepak L.} and Umberto Bendetto and Claudio Rapezzi and Stone, {Gregg W.}",
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Palmerini, T, Sangiorgi, D, Valgimigli, M, Biondi-Zoccai, G, Feres, F, Abizaid, A, Costa, RA, Hong, MK, Kim, BK, Jang, Y, Kim, HS, Park, KW, Mariani, A, Della Riva, D, Genereux, P, Leon, MB, Bhatt, DL, Bendetto, U, Rapezzi, C & Stone, GW 2015, 'Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis', Journal of the American College of Cardiology, vol. 65, no. 11, pp. 1092-1102. https://doi.org/10.1016/j.jacc.2014.12.046

Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation : An individual patient data pairwise and network meta-analysis. / Palmerini, Tullio; Sangiorgi, Diego; Valgimigli, Marco; Biondi-Zoccai, Giuseppe; Feres, Fausto; Abizaid, Alexandre; Costa, Ricardo A.; Hong, Myeong Ki; Kim, Byeong Keuk; Jang, Yangsoo; Kim, Hyo Soo; Park, Kyung Woo; Mariani, Andrea; Della Riva, Diego; Genereux, Philippe; Leon, Martin B.; Bhatt, Deepak L.; Bendetto, Umberto; Rapezzi, Claudio; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 65, No. 11, 24.03.2015, p. 1092-1102.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation

T2 - An individual patient data pairwise and network meta-analysis

AU - Palmerini, Tullio

AU - Sangiorgi, Diego

AU - Valgimigli, Marco

AU - Biondi-Zoccai, Giuseppe

AU - Feres, Fausto

AU - Abizaid, Alexandre

AU - Costa, Ricardo A.

AU - Hong, Myeong Ki

AU - Kim, Byeong Keuk

AU - Jang, Yangsoo

AU - Kim, Hyo Soo

AU - Park, Kyung Woo

AU - Mariani, Andrea

AU - Della Riva, Diego

AU - Genereux, Philippe

AU - Leon, Martin B.

AU - Bhatt, Deepak L.

AU - Bendetto, Umberto

AU - Rapezzi, Claudio

AU - Stone, Gregg W.

PY - 2015/3/24

Y1 - 2015/3/24

N2 - Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

AB - Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

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