Waksman, Ron

Duration of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation in Diabetic and Non-Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. [Review] - 2018

Available in print through MWHC library: 2004 - 2006

BACKGROUND: Diabetic patients account for an increasing number of patients undergoing percutaneous coronary intervention (PCI). However, diabetes mellitus (DM) is associated with increased residual platelet activity during dual antiplatelet treatment (DAPT) and DM patients have worse clinical outcomes after PCI as compared to non-DM. OBJECTIVE: To evaluate efficacy and safety of short duration DAPT (S-DAPT) and long duration DAPT (L-DAPT) after drug eluting stent (DES) implantation in DM and non-DM patients. METHODS: We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the effect of S-DAPT versus L-DAPT after DES implantation in DM and non-DM patients. Efficacy endpoints were all-cause mortality, cardiac mortality, myocardial infarction (MI), stent thrombosis (ST), target vessel revascularization (TVR), and composite end point of net adverse clinical events (NACE) (all cause mortality, cardiac mortality, MI, ST, TVR, stroke, major bleeding). Safety endpoints were major bleeding and stroke. Event rates were compared using a forest plot of relative risk using a random effects model. RESULTS: We included eight RCTs that randomized 28,318 patients to S-DAPT versus L- DAPT (8,234 DM and 20,084 non-DM). S-DAPT was associated with an increased rate of ST in non-DM patients [3.67 (2.04, 6.59)]. There was no significant difference in the rate of all cause mortality, cardiac mortality, ST, MI, TVR, major bleeding, stroke and NACE with S-DAPT and L-DAPT in DM patients [1.19 (0.72-1.95); 1.25 (0.69, 2.25); 1.52 (0.70, 3.29); 1.33 (0.88, 2.01); 1.39 (0.89, 2.17); 0.92 (0.19, 4.42); 0.98 (0.29, 3.28); and 0.94 (0.57, 1.54) respectively]. Further, there was no significant difference in the rate of all cause mortality, cardiac mortality, MI, TVR, major bleeding, stroke and NACE with S-DAPT and L-DAPT in non-DM patients [0.93 (0.58, 1.48); 0.75 (0.42, 1.35); 1.52 (0.81, 2.83); 0.99 (0.71, 1.39); 0.72 (0.28, 1.84); 1.01 (0.40, 2.56); and 1.01 (0.77, 1.32) respectively]. CONCLUSION: Compared to L-DAPT, S-DAPT was associated with significant increase in rate of ST in non-DM patients. Duration of DAPT had no significant impact on rates of all cause mortality, cardiac mortality, MI, ST and TVR among DM patients. Copyright (c) 2017. Published by Elsevier Inc.


English

0033-0620

S0033-0620(17)30165-2 [pii] 10.1016/j.pcad.2017.12.003 [doi]


Comorbidity
Coronary Artery Disease/mo [Mortality]
Coronary Artery Disease/th [Therapy]
*Coronary Artery Disease
*Diabetes Mellitus/ep [Epidemiology]
*Drug Therapy, Combination/mt [Methods]
*Drug-Eluting Stents/ae [Adverse Effects]
Humans
Percutaneous Coronary Intervention/ae [Adverse Effects]
Percutaneous Coronary Intervention/is [Instrumentation]
Percutaneous Coronary Intervention/mt [Methods]
*Percutaneous Coronary Intervention
*Platelet Aggregation Inhibitors/pd [Pharmacology]
Randomized Controlled Trials as Topic
Risk Adjustment
Time Factors


MedStar Heart & Vascular Instituteon


Journal Article
Review

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