Duration of dual antiplatelet therapy in patients with acute coronary syndrome undergoing drug-eluting stent implantation: A meta-analysis

Objective This meta-analysis was performed to evaluate the optimal discontinuation of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation in acute coronary syndrome (ACS) patients. Methods A systematic search was conducted without language restrictions using PubMed, the Cochrane Library, and Clinical Trials.gov from January 2008 to July 2019. Studies that met the following criteria were included: (1) randomized trials that compared DAPT durations of <12 months ("short DAPT") or >= 12 months ("long DAPT"); (2) studies that included data on patients with ACS; and (3) studies that included data on outcomes. The outcomes were pooled using the Mantel-Haenszel model, generating relative risk (RR) and 95% confidence intervals (CI). Statistical heterogeneity was evaluated using the Cochrane Q statistic P-value and I-2 value. Publication bias was assessed by visually inspecting the funnel plots. Results Eight studies comprising 10,537 participants were included in the analysis. The primary endpoint was not different between short-term and long-term DAPT (RR, 1.11; 95% CI, 0.92-1.34). Conclusion A meta-analysis of the available evidence suggests that DAPT can be reduced to 3 or 6 months without increasing the risk of cardiovascular and cerebrovascular events in patients with ACS who are undergoing DES implantation.