Comprehensive Outcomes Evaluation After Percutaneous Coronary Intervention in Stable Ischemic Heart Disease and Acute
Mukul Bhattarai1, Abdisamad M Ibrahim2, Mohsin Salih1
1Division of Cardiology, Southern Illinois University, School of Medicine, Springfield, IL.
Insights
Shorter dual antiplatelet therapy (DAPT) of 3-6 months after drug-eluting stents (DES) reduces major bleeding but increases repeat revascularization compared to 12 months. No significant differences in mortality or heart attack were found.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Drug-eluting stents (DES) and pharmacotherapy have improved outcomes after percutaneous coronary intervention (PCI).
- Optimal duration of dual antiplatelet therapy (DAPT) following DES implantation remains debated, especially comparing short-term (3-6 months) versus standard-term (12 months).
- Limited comprehensive safety and efficacy data exist for these DAPT durations in both stable ischemic heart disease and acute coronary syndrome.
Purpose of the Study:
- To evaluate the safety and efficacy of short-term (3-6 months) versus standard-term (12 months) DAPT after PCI with DES.
- To compare key clinical outcomes including mortality, myocardial infarction, stent thrombosis, bleeding, and revascularization.
- To analyze data from randomized controlled trials (RCTs) in patients with stable ischemic heart disease and acute coronary syndrome.
Main Methods:
- Systematic search of electronic databases for RCTs comparing DAPT durations after DES PCI.
- Inclusion criteria: DAPT durations of 3-6 months versus 12 months, follow-up ≥12 months.
- Exclusion criteria: DAPT <3 months or DAPT ≥12 months.
- Outcomes assessed: all-cause mortality, myocardial infarction, stent thrombosis, major bleeding, target lesion/vessel revascularization, and stroke.
Main Results:
- Thirteen RCTs (n=31,831) were included.
- Short-term DAPT (3-6 months) was associated with significantly lower rates of major bleeding (RR 0.66; 95% CI, 0.52-0.84).
- Short-term DAPT was associated with significantly higher rates of repeat revascularization (RR 1.17; 95% CI, 1.01-1.36).
- No significant differences were observed for all-cause mortality, myocardial infarction, stent thrombosis, or stroke between the groups.
Conclusions:
- Short-term DAPT (3-6 months) following DES implantation offers a significant reduction in major bleeding events.
- The benefit of reduced bleeding with shorter DAPT comes at the cost of an increased risk of repeat revascularization.
- Current evidence suggests no significant trade-off in major adverse cardiovascular events like mortality or myocardial infarction when comparing short-term versus standard-term DAPT in diverse patient populations undergoing PCI with DES.
Abstract:
Newer generation drug eluting stents (DES) and pharmacotherapy have decreased thrombotic events post-percutaneous coronary intervention (PCI). There is lack of wide-ranging safety and efficacy evaluation in both stable ischemic heart disease and acute coronary syndrome in short-term (3-6 months) versus Standard-term (12 months) dual antiplatelet therapy (DAPT). We searched electronic databases using specific terms to identify randomized control trials comparing different durations of DAPT after PCI with DES. The outcomes of interest included all-cause mortality, myocardial infarction, stent thrombosis, major bleeding, target lesion and vessel revascularization, and stroke at follow-up duration ≥12 months post index PCI. Studies that compared DAPT <3 months or DAPT ≥12 months were excluded. Thirteen randomized control trials (n = 31,831) were included; 8401 patients received DAPT for 3 months and 7482 patients received DAPT in the 6 months group. Major bleeding rate was lower in the short-term (3-6 months) versus Standard-term (12 months) group (risk ratio 0.66; 95% confidence interval, 0.52-0.84, P < 0.05). Repeat revascularization rate was higher in the short-term (3-6 months) versus Standard-term (12 months) (risk ratio 1.17; 95% confidence interval, 1.01-1.36, P < 0.05) of DAPT duration after PCI with DES. No difference in other outcomes were observed when comparing short versus standard duration of DAPT in both stable ischemic heart disease and acute coronary syndrome.
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