背景:经皮冠状动脉介入治疗的患者主要接受抗血小板治疗。然而,关于新一代药物洗脱支架(DES)植入后最佳双联抗血小板治疗(DAPT)的现有数据有限.
目的:本研究旨在比较新一代DES植入后短期(1-3个月)DAPT和标准(12个月)DAPT的临床结果。
方法:我们系统地搜索了PubMed,Cochrane图书馆数据库,Embase用于比较植入下一代DES后的短期(1-3个月)和标准DAPT的试验,从所有已发表的英文研究中检索,直到2021年12月31日。主要终点是大出血。次要终点包括全因死亡率,心脏死亡,心肌梗塞,中风,支架内血栓形成,所有的出血。
结果:本研究共纳入7项随机对照试验,包括28,344名受试者。关于主要终点,与标准DAPT相比,短期DAPT显示出明显较低的大出血发生率[相对危险度(RR):0.66,95%置信区间(CI):(0.54,0.81),P<.0001].对于次要端点,在所有出血中,短期DAPT和标准DAPT之间存在显着差异[RR:0.59,95%CI:(0.50,0.69),P<.00001].然而,全因死亡率无显著差异[RR:0.96,95%CI:(0.77,1.18),P=.27],心肌梗死[RR:0.98,95%CI:(0.82,1.18),P=.86],心源性死亡[RR:0.83,95%CI:(0.63,1.10),P=.20],卒中[RR:1.08,95%CI:(0.79,1.47),P=.63],脑血管[RR:1.08,95%CI:(0.79,1.47),P=.63],和支架血栓形成[RR:1.13,95%CI:(0.80,1.57),两组之间P=0.49]。
结论:在接受新一代DES植入的患者中,在全因死亡率方面,短期(1-3个月)DAPT与标准(12个月)DAPT相比没有劣势,心脏死亡,心肌梗塞,中风,与标准(12个月)DAPT相比,明确或可能的支架内血栓形成。然而,短期DAPT在大出血和所有出血方面似乎优于标准DAPT.
BACKGROUND: Patients undergoing percutaneous coronary intervention mainly receive antiplatelet therapy. However, limited data are available regarding the optimal dual antiplatelet therapy (DAPT) following the implantation of new-generation drug-eluting stent (DES).
OBJECTIVE: This study aimed to compare the clinical outcomes of short-term (1-3 months) DAPT and standard (12 months) DAPT after the implantation of a new-generation of DES.
METHODS: We systematically searched PubMed, The Cochrane Library Database, Embase for trials that compared short-term (1-3 months) and standard DAPT after the implantation of next-generation DES were retrieved from all published studies in English until December 31, 2021. The primary endpoint was major bleeding. The secondary endpoints included all-cause mortality, cardiac death, myocardial infarction, stroke, stent thrombosis, and all bleeding.
RESULTS: This study included a total of 7 randomized controlled trials, comprising 28,344 subjects. Regarding primary endpoints, short-term DAPT exhibited a significantly lower incidence of major bleeding compared with standard DAPT [relative risk (RR): 0.66, 95% confidence interval (CI): (0.54, 0.81), P < .0001]. For secondary endpoints, there were significant differences between short-term and standard DAPT in all bleeding [RR: 0.59, 95% CI: (0.50, 0.69), P < .00001]. However, no significant differences were identified in all-cause mortality [RR: 0.96, 95% CI: (0.77, 1.18), P = .27], myocardial infarction [RR: 0.98, 95% CI: (0.82, 1.18), P = .86], cardiac death [RR: 0.83, 95% CI: (0.63, 1.10), P = .20], stroke [RR: 1.08, 95% CI: (0.79, 1.47), P = .63], cerebrovascular [RR: 1.08, 95% CI: (0.79, 1.47), P = .63], and stent thrombosis [RR: 1.13, 95% CI: (0.80, 1.57), P = .49] between the 2 groups.
CONCLUSIONS: In patients undergoing implantation of a new-generation of DES, short-term (1-3 months) DAPT exhibited no inferiority compared with standard (12 months) DAPT in terms of all-cause mortality, cardiac death, myocardial infarction, stroke, and definite or probable stent thrombosis compared with standard (12 months) DAPT. However, short-term DAPT appeared superior to standard DAPT in terms of major bleeding and all bleeding.