The optimal duration of dual antiplatelet therapy in East Asian patients undergoing percutaneous coronary intervention with drug-eluting stents: a meta-analysis of randomized trials

Objective The optimal duration of dual antiplatelet therapy (DAPT) is still controversial among East Asians. This meta-analysis was designed to evaluate the efficacy and safety of short-term (<= 6 months) vs. long-term (>= 12 months) DAPT in East Asians undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Methods PubMed, Embase, Web of Science and the Cochrane Library were searched for articles published up to 30 March 2020. Then meta-analysis was performed using RevMan 5.3 software. Results Nine studies with a total of 20 177 East Asian patients were included in this meta-analysis. In East Asian patients, short-term DAPT was associated with a lower incidence of major bleeding [odds ratio (OR) = 0.70, 95% confidence interval (CI) (0.49, 0.99), P = 0.04]. In the newer-generation DES subgroup, short-term DAPT was no less effective than long-term DAPT and resulted in a lower incidence of major bleeding [OR = 0.69, 95% CI (0.49, 0.98), P = 0.04]. In the subgroup of patients with acute coronary syndrome, there was no significant difference in the incidence of cardiac death, net adverse clinical and cerebral events (NACCE) and major bleeding between short-term and long-term DAPT. It was worth noting that in the subgroup of patients with diabetes mellitus, short-term DAPT was associated with a higher incidence of myocardial infarction [OR = 2.64, 95% CI (1.19, 5.88), P = 0.02] and NACCE [OR = 1.92, 95% CI (1.07, 3.43), P = 0.03]. Conclusion The short-term DAPT (<= 6 months) might be a better choice for East Asian patients undergoing PCI with DES, especially the newer-generation DES. However, for high-risk patients such as diabetes, the analysis supported the longer DAPT.