Efficacy and safety of short‐term dual antiplatelet therapy (≤6 months) after percutaneous coronary intervention for acute coronary syndrome: A systematic review and meta‐analysis of randomized controlled trials

摘要

Background Patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are at increased risk for subsequent ischemic events. Hypothesis Short‐term dual antiplatelet therapy (DAPT) (≤6 months) is inferior to standard or long‐term DAPT in patients who undergo PCI for ACS events. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials that compared short‐term (≤6 months) to long‐term (≥12?months) DAPT after PCI for ACS. We searched MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials database. Results Ten randomized controlled trials, including a total of 12?696 patients, met our inclusion criteria. For short‐term DAPT, duration of therapy ranged from 3 to 6 months, while long‐term DAPT ranged from 12 to 24?months. The majority of studies used clopidogrel and second‐generation drug‐eluting stents. No statistically significant difference was found between short‐term and long‐term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94‐1.57; P =?0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00‐2.38; P =?0.052), or major bleeding events (odds ratio 0.74; 95% confidence interval 0.49‐1.11; P =?0.14). There was no significant difference in all‐cause mortality, cardiac death, or net adverse cardiac and cerebrovascular events. Conclusions Our meta‐analysis demonstrated that short‐term DAPT (6?months) after PCI for ACS was not associated with increased risk of myocardial infarction or stent thrombosis when compared to long‐term DAPT.