Optimal duration of dual antiplatelet therapy followed by monotherapy in diabetic patients after percutaneous coronary intervention with drug-eluting stent implantation: a Bayesian network meta-analysis
Optimal duration of dual antiplatelet therapy followed by monotherapy in diabetic patients after percutaneous coronary intervention with drug-eluting stent implantation: a Bayesian network meta-analysis
复制标题
糖尿病患者经皮冠状动脉介入治疗药物洗脱支架植入后双联抗血小板治疗随后单一治疗的最佳持续时间：贝叶斯网络荟萃分析
DOI：
10.20452/pamw.16032
复制
发表时间：
2021-09-30
影响因子：
4.8
通讯作者：
Wang, Shaohua
中科院分区：
文献类型：
--
作者：
An, Ke;Guo, Peng;Wang, Shaohua
推荐用于普通人群的经皮冠状动脉介入治疗（PCI）后药物洗脱支架（DES）植入标准的12个月双重抗血小板治疗（DAPT）可能不适合糖尿病患者。目的：本研究旨在评估短期（12个月）DAPT治疗DES植入的糖尿病患者的疗效和安全性，并比较停用DAPT后单药治疗阿司匹林与P2Y12受体抑制剂的结果。患者和方法在PubMed、Web of Science、Embase、Cochrane Library和ClinicalTrials.gov数据库中检索截至2020年10月10日发表的随机对照试验。采用随机效应模型进行贝叶斯网络元分析。共纳入18项随机试验，涉及20536例糖尿病患者。结果网络分析显示，短期DAPT在减少主要终点方面效果最佳，优于长期DAPT（优势比[OR]， 0.48; 95% CI, 0.25-0.85）。与延长期DAPT相比，标准期DAPT还与减少的主要终点相关（OR, 0.56; 95% CI, 0.32-0.90）。短期DAPT联合阿司匹林单药治疗和P2Y12抑制剂治疗的主要终点无显著差异。次要终点无显著差异，包括全因死亡率、心脏死亡率、心肌梗死、卒中、靶血管重建术、明确或可能的支架血栓形成和大出血事件。结论：与长期治疗相比，短期DAPT与PCI合并DES植入后糖尿病患者的主要终点降低相关。
INTRODUCTION The standard 12-month dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation that is recommended for the general population may not be suitable for patients with diabetes.OBJECTIVES The study aimed to evaluate the efficacy and safety of short-term (12 months) DAPT in diabetic patients with DES implantation and to compare the outcomes of DAPT discontinuation followed by monotherapy with aspirin versus a P2Y12 receptor inhibitor.PATIENTS AND METHODS Randomized controlled trials published up to October 10, 2020 were searched in the PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov databases. A Bayesian network meta-analysis with a random-effects model was performed. A total of 18 randomized trials involving 20 536 patients with diabetes were included.RESULTS The network analysis showed that short-term DAPT was the most optimal in terms of reducing the primary endpoint and was superior to extended-term DAPT (odds ratio [OR], 0.48; 95% CI, 0.25-0.85). Standard-term DAPT was also associated with a reduced primary endpoint in comparison with extended-term DAPT (OR, 0.56; 95% CI, 0.32-0.90). There was no noticeable difference with respect to the primary endpoint between short-term DAPT followed by monotherapy with aspirin and a P2Y12 inhibitor. No significant differences were observed in secondary endpoints, including all-cause mortality, cardiac mortality, myocardial infarction, stroke, target vessel revascularization, definite or probable stent thrombosis, and major bleeding event.CONCLUSIONS Short-term DAPT, as compared with extended-term therapy, was associated with a reduced primary endpoint in patients with diabetes after PCI with DES implantation.