The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is still debated. Current American and European guidelines recommend at least 6 months of DAPT after drug-eluting stent placement in stable coronary artery disease, and at least 12 months after acute coronary syndrome. , Recent advances with newer stent generations have helped reduce the duration of DAPT. A recent meta-analysis assessed short-term DAPT (1 to 3 months) versus standard DAPT (12 to 24 months) and reported lower bleeding risks with similar ischemic events using the abbreviated DAPT duration. More recent evidence accumulated since then for even shorter duration (1-month DAPT) has shown promising results. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the safety and efficacy of 1-month DAPT in this population.
We conducted a systematic search of multiple databases (PubMed, Google Scholar, Cochrane, and Cumulative Index to Nursing and Allied Health Literature) using prespecified terms from inception until October 1, 2021. RCTs comparing 1-month DAPT followed by antiplatelet monotherapy (SAPT) versus standard DAPT (≥3 months) in patients who underwent PCI were included. Patients with or without high bleeding risk (HBR) were eligible. The primary outcome of interest was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), ischemic/hemorrhagic stroke, definite stent thrombosis, target vessel revascularization, and major bleeding. We pooled data using RevMan 5.4 software using the random-effects model.
A total of 4 RCTs with 26,576 patients (1-month DAPT = 13,282; standard DAPT = 13,294) were included. The mean age was 67.2 ± 10.9 years, and 25.3% were women. The mean follow-up was 15 ± 6 months. Most patients (71.4%) had hypertension, and 29.6% had diabetes; 45.5% of patients had acute coronary syndrome, 31% of patients had previous PCI, and 5% had previous coronary artery bypass graft. One study exclusively included patients with HBR.
There were no differences between both groups with regard to all-cause mortality (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.77 to 1.04, p = 0.14), nonfatal MI (OR 1.02, 95% CI 0.87 to 1.19, p = 0.81), stroke (OR 0.77, 95% CI 0.54 to 1.08, p = 0.13), stent thrombosis (OR 1.08, 95% CI 0.79 to 1.47, p = 0.64), target vessel revascularization (OR 1.04, 95% CI 0.76 to 1.42, p = 0.81), and major bleeding (OR 0.74, 95% CI 0.52 to 1.06, p = 0.10) ( Figure 1 ).
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