Meta-Analysis of the Efficacy and Safety of P2Y12 Inhibitor Monotherapy After Short Course of Dual-Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

Background: Guidelines recommend dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) placement for >= 12 months in acute coronary syndrome or 6 months in stable coronary artery disease. However, with the advent of newer-generation stents, the optimal duration of DAPT to balance bleeding and thrombotic risks has been debated. Objectives: We aimed to perform a meta-analysis of randomized controlled trials (RCT) comparing P2Y(12) mono-therapy in short-duration group (SDG) vs. standard treatment group (STG) course of DAPT in patients undergoing PCI. Methods: Electronic databases were searched for RCTs of patients undergoing percutaneous coronary intervention (PCI) with DES placement who received short (<= 3 months) vs. standard DAPT course (>= 12 months) and were followed for >= 12-months. Rates ofmajor adverse cardiovascular events (a composite of cardiovascularmortality, non-fatal myocardial infarction, and non-fatal stroke) were the primary outcome. Study-specific odds ratios (OR) and corresponding 95% confidence intervals were calculated using random-effects model. Results: A total of 20,706 patients (10,344 in the SDG and 10,362 in the STG) were analysed from four studies. There was no significant difference observed forMACE (OR= 0.95, 95% CI: 0.81-1.08, P =.92, I-2= 0%) myocardial infarction or stent thrombosis. However, lower rates ofmajor bleedingwere noted in the SDG (1.20 vs. 1.80%; OR: 0.61; 95% CI: 0.37-0.99; P =.04; I-2 = 71%) albeit with increased heterogeneity. Conclusion: A short duration of DAPT followed by P2Y(12) inhibitormonotherapy was comparable to 12 months of DAPT with respect to MACE and thrombotic events, with lower rates of major bleeding events in select group of patients undergoing PCI. More data is needed to assess efficacy in patients with complex lesions and high risk ACS population including those with STEMI presentation. (C) 2020 Elsevier Inc. All rights reserved.