Comparison of the Efficacy of Dual Antiplatelet Treatment at Different Treatment Times in Patients with High Bleeding Risk after PCI: A Systematic Review and Meta-analysis of Randomized Controlled Trials
DOI:
https://doi.org/10.59958/hsf.7419Keywords:
percutaneous coronary intervention, dual antiplatelet therapy, randomized controlled trial, meta-analysisAbstract
Objective: This study conducted a systematic review and meta-analysis to evaluate the efficacy and complications of dual antiplatelet therapy in patients with high bleeding risk after percutaneous coronary intervention (PCI) at different treatment durations. Methods: Related studies were searched in PubMed, Web of Science, Cochrane Library, Google Scholar, China national knowledge infrastructure (CNKI), Wanfang, Embase, and VIP databases from the establishment of the database to May 2023. Randomized controlled trials (RCTs) of dual antiplatelet treatment (DAPT) time limit for germination of the coronary artery were screened, and results were integrated and analyzed. The study assessed literature quality using the Jadad scale and conducted meta-analyses with RevMan 5.4, applying appropriate models based on heterogeneity and using Egger's test for publication bias. Sensitivity analysis identified factors contributing to heterogeneity. Results: Fifteen studies with 193,086 patients with PCI, comprising 102,661 cases of DAPT short-term treatment groups (<12 months) and 88,988 cases of DAPT long-term treatment groups (≥12 months), were analyzed. Meta-analysis results showed that the total mortality of short-term DAPT PCI was significantly reduced compared with long-term treatment (relative risk (RR) = 0.49, 95% CI: 0.48–0.51). Cardiac mortality showed a significant decrease (RR = 0.50, 95% CI: 0.48–0.52); Myocardial infarction: The risk of myocardial infarction was significantly reduced (RR = 0.68, 95% CI: 0.66–0.70); There was a significant increase in the risk of stroke (RR = 1.45, 95% CI: 1.37–1.53); The incidence of target vessel revascularization (TVR) showed a significant increase (RR = 1.35, 95% CI: 1.08–1.69); The risk of major bleeding was significantly increased (RR = 1.46, 95% CI: 1.40–1.51). Definite stent thrombosis and incidence of minor bleeding did not increase significantly. Conclusion: Short-course dual antiplatelet therapy (DAPT) has been shown to decrease overall mortality, cardiac mortality, and the risk of myocardial infarction in patients following percutaneous coronary intervention (PCI). However, it is associated with an elevated risk of major bleeding, stroke, and target vessel revascularization (TVR), while the risks of definite stent thrombosis and minor bleeding did not increase significantly. Additional high-quality RCTs should be used to verify the conclusions.
References
Jneid H. Insights and Opportunities in STEMI Care in China. JAMA Cardiology. 2022; 7: 492–493.
Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, et al. 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. Lancet Regional Health. Americas. 2022; 9: None.
Compilation Group of “China State Cardiovascular Health and Diseases”. Overview of ‘China Cardiovascular Health and Disease Report 2021’. Research on Cardiovascular Diseases in China. 2022; 577–596. (In Chinese)
Medical Quality Control of the Guojia Heart Blood Diseases Medical Expert Member Member Coronary Heart Disease Expert Work Group. In 2019, the adult acute ST section lifts the heavier myocardial infarction medical quality control report. China Cycle Magazine. 2020; 313–325. (In Chinese)
Valgimigli M, Frigoli E, Heg D, Tijssen J, Jüni P, Vranckx P, et al. Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk. The New England Journal of Medicine. 2021; 385: 1643–1655.
Batchelor R, Dinh D, Brennan A, Lefkovits J, Reid C, Duffy SJ, et al. Incidence, Predictors and Clinical Outcomes of Stent Thrombosis Following Percutaneous Coronary Intervention in Contemporary Practice. Heart, Lung & Circulation. 2020; 29: 1433–1439.
Sullivan AE, Nanna MG, Wang TY, Bhatt DL, Angiolillo DJ, Mehran R, et al. Bridging Antiplatelet Therapy After Percutaneous Coronary Intervention: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2021; 78: 1550–1563.
The Chinese Medical Division Association Association Cardiovascular Medicine Division Branch. Consensus of expert consensus on the treatment of anti -thrombus treatment of acute coronary syndrome combined with hematopoietic anti -treatment multiple disciplines. Chinese Journal of Internal Medicine. 2016; 813–824. (In Chinese)
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139: e56–e528.
Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. European Heart Journal. 2018; 39: 213–254.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2019; 40: 87–165.
Miller TD. Comparison of the AHA/ACC vs ESC guidelines for management of patients with non-ST-elevation acute coronary syndromes: Are the differences clinically different? Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology. 2018; 25: 777–779.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). Giornale Italiano Di Cardiologia (2006). 2019; 20: 1S–61S. (In Italian)
Kamran H, Jneid H, Kayani WT, Virani SS, Levine GN, Nambi V, et al. Oral Antiplatelet Therapy After Acute Coronary Syndrome: A Review. JAMA. 2021; 325: 1545–1555.
Shu X, Guo T. Platelet receptor as the research progress of the target of anti -platelet treatment. Clinical Hematology Magazine. 2020; 13–17. (In Chinese)
Yang J, Zhao Y, Zhang J. Different anti -platelet treatment plans on acute coronary syndrome combined with baseline platelet moderate reduction of patient prognosis. Clinical Cardiovascular Disease Magazine. 2021; 21–27. (In Chinese)
Varenhorst C, Lindholm M, Sarno G, Olivecrona G, Jensen U, Nilsson J, et al. Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. 2018; 107: 816–823.
Edfors R, James S, Szummer K, Evans M, Carrero JJ, Faxén J, et al. SWEDEHEART-1-year data show no benefit of newer generation drug-eluting stents over bare-metal stents in patients with severe kidney dysfunction following percutaneous coronary intervention. Coronary Artery Disease. 2020; 31: 49–58.
Kimura T, Akahori H, Tanaka T, Yanaka K, Yoshihara N, Miki K, et al. Impact of lipoprotein (a) on long-term outcome after percutaneous coronary intervention in the era of new generation drug-eluting stents. Journal of Cardiology. 2022; 80: 179–183.
Kang J, Kim HS. The Evolving Concept of Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: Focus on Unique Feature of East Asian and “Asian Paradox”. Korean Circulation Journal. 2018; 48: 537–551.
Kwon O, Park DW. Antithrombotic Therapy After Acute Coronary Syndromes or Percutaneous Coronary Interventions in East Asian Populations. JACC. Asia. 2022; 2: 1–18.
Hahn JY, Song YB, Oh JH, Cho DK, Lee JB, Doh JH, et al. 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial. Lancet (London, England). 2018; 391: 1274–1284.
Kinlay S, Young MM, Sherrod R, Gagnon DR. Long-Term Outcomes and Duration of Dual Antiplatelet Therapy After Coronary Intervention With Second-Generation Drug-Eluting Stents: The Veterans Affairs Extended DAPT Study. Journal of the American Heart Association. 2023; 12: e027055.
Redfors B, Kirtane AJ, Liu M, Musikantow DR, Witzenbichler B, Rinaldi MJ, et al. Dual Antiplatelet Therapy Discontinuation, Platelet Reactivity, and Adverse Outcomes After Successful Percutaneous Coronary Intervention. JACC. Cardiovascular Interventions. 2022; 15: 797–806.
Shen D, Lu M, Xing L. Long-term prognosis of patients who discontinue antiplatelet therapy after PCI for coronary heart disease. Chinese Journal of Emergency Resuscitation and Disaster Medicine. 2021; 609–612. (In Chinese)
Wang G, Gan J, Zhong W. A study on the duration of dual antiplatelet administration and prognosis in patients with coronary heart disease after DES implantation. Chinese Journal of Evidence-Based Cardiovascular Medicine. 2018; 283–287. (In Chinese)
Didier R, Morice MC, Barragan P, Noryani AAL, Noor HA, Majwal T, et al. 6- Versus 24-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents in Patients Nonresistant to Aspirin: Final Results of the ITALIC Trial (Is There a Life for DES After Discontinuation of Clopidogrel). JACC. Cardiovascular Interventions. 2017; 10: 1202–1210.
Koskinas KC, Zanchin T, Klingenberg R, Gencer B, Temperli F, Baumbach A, et al. Incidence, Predictors, and Clinical Impact of Early Prasugrel Cessation in Patients With ST-Elevation Myocardial Infarction. Journal of the American Heart Association. 2018; 7: e008085.
Dadjou Y, Safavi S, Kojuri J. Risks and Benefits of Dual Antiplatelet Therapy Beyond 12 Months After Coronary Stenting: A Prospective Randomized Cohort Study. Medicine. 2016; 95: e3663.
Hermiller JB, Krucoff MW, Kereiakes DJ, Windecker S, Steg PG, Yeh RW, et al. Benefits and Risks of Extended Dual Antiplatelet Therapy After Everolimus-Eluting Stents. JACC. Cardiovascular Interventions. 2016; 9: 138–147.
Yeh RW, Secemsky EA, Kereiakes DJ, Normand SLT, Gershlick AH, Cohen DJ, et al. Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention. JAMA. 2016; 315: 1735–1749.
Han Y, Xu B, Xu K, Guan C, Jing Q, Zheng Q, et al. Six Versus 12 Months of Dual Antiplatelet Therapy After Implantation of Biodegradable Polymer Sirolimus-Eluting Stent: Randomized Substudy of the I-LOVE-IT 2 Trial. Circulation. Cardiovascular Interventions. 2016; 9: e003145.
Hong SJ, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, et al. 6-Month Versus 12-Month Dual-Antiplatelet Therapy Following Long Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JACC. Cardiovascular Interventions. 2016; 9: 1438–1446.
Helft G, Steg PG, Le Feuvre C, Georges JL, Carrie D, Dreyfus X, et al. Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial. European Heart Journal. 2016; 37: 365–374.
Gilard M, Barragan P, Noryani AAL, Noor HA, Majwal T, Hovasse T, et al. 6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin: the randomized, multicenter ITALIC trial. Journal of the American College of Cardiology. 2015; 65: 777–786.
Schulz-Schüpke S, Byrne RA, Ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, et al. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. European Heart Journal. 2015; 36: 1252–1263.
Mauri L, Kereiakes DJ, Yeh RW, Driscoll-Shempp P, Cutlip DE, Steg PG, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. The New England Journal of Medicine. 2014; 371: 2155–2166.
Wang X, Xi S, Liu J. Analysis of the influence of clinical return of Grairo for patients with coronary cardiopathy and drug discontinuation on clinical return. China Elderly Multi -Organic Diseases Magazine. 2016; 231–236. (In Chinese)
Zhao Y, Hui H, Sun S. The impact of the treatment of Garrilo monoclonal treatment on PCI patient cardiovascular events and bleeding incidents. Chinese and Western Medicine Combined with Cardiovascular and Cerebrovascular Diseases. 2023; 325–327. (In Chinese)
Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, et al. Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis. Lancet (London, England). 2015; 385: 792–798.
Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145: e4–e17.
Jang WJ, Ahn SG, Song YB, Choi SH, Chun WJ, Oh JH, et al. Benefit of Prolonged Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stent for Coronary Bifurcation Lesions: Results From the Coronary Bifurcation Stenting Registry II. Circulation. Cardiovascular Interventions. 2018; 11: e005849.
Rozemeijer R, Voskuil M, Greving JP, Bots ML, Doevendans PA, Stella PR. Short versus long duration of dual antiplatelet therapy following drug-eluting stents: a meta-analysis of randomised trials. Netherlands Heart Journal: Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2018; 26: 242–251.
Lee BK, Kim JS, Lee OH, Min PK, Yoon YW, Hong BK, et al. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C Randomised Clinical Trial and OCT Substudy. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2018; 13: 1923–1930.
Xu K, Xu B, Guan C, Jing Q, Zheng Q, Li X, et al. Biodegradable polymer-coated versus durable polymer-coated sirolimus-eluting stents: the final 5-year outcomes of the I-LOVE-IT 2 trial. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2021; 16: e1518–e1526.
Published
How to Cite
Issue
Section
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.