부산대학교 도서관

Introduction:Dual antiplatelet therapy (DAPT) is recommended as a standard treatment for patients with the acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) using drug-eluting stents (DES).The optimal duration for DAPT has been an ongoing debate. Purpose of our study is to compare the safety and efficacy of shorter therapy i.e. DAPT for 3 months, from longer therapy i.e. DAPT for 12 months.Methods:We searched PubMed, Ovid Embase, Web of science, Cochrane library and Clinicaltrials.gov for studies reporting the comparative use of DAPT for 3 months versus 12 months after PCI in patients with ACS. The primary endpoint was all-cause mortality. Secondary outcomes were cardiovascular mortality (CVM), post-PCI myocardial infarction (MI), stent thrombosis, major adverse cardiovascular events (MACE) and target vessel revascularization (TVR).Results:Four studies- three randomized control trials and one retrospective study, with N= 22016 were included. Out of these, 11263 patients received shorter DAPT while 10753 patients received longer DAPT. Our results indicated that shorter DAPT showed similar efficacy to longer DAPT in regards to of all-cause mortality [RR = 0.86 (0.66-1.12), p= 0.225] and CVM [RR = 0.82 (0.52-1.29), p= 0.381]. In terms of safety, there was no difference between the two groups in rates of post-PCI MI [RR = 1.01 (0.86-1.18), p= 0.927], MACE [RR = 0.933 (0.82-1.06), p= 0.274], stroke [RR= 0.98 (0.73-1.31), p= 0.885], stent thrombosis [RR: 0.99 (0.73-1.34), p= 0.937], bleeding events [RR = o.91 (0.75-1.10), p= 0.314] and TVR [.RR= 0.91 (0.81-1.03), p= 0.133].Conclusion:Our study supports that DAPT given for only 3 months followed by monotherapy(either with plavix or ticagrelor) shows comparable efficacy and safety to treatment with DAPT over 12 months in patients post-PCI with DES placement especially after non-ST segment elevation ACS.