Duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for bifurcation lesions: a systematic review and meta-analysis.
Ricardo F O Suruagy-Motta, Julia Tirelli-Rocha, Luiz Guilherme Silva Almeida et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared short-term (≤6 months) with long-term (>6 months) dual antiplatelet therapy after drug-eluting stent PCI for coronary bifurcation lesions. Six studies included 12 066 patients. Short-term DAPT was associated with higher risks of MACE, all-cause and cardiac mortality, and stent thrombosis; for MACE, the pooled relative risk was 1.79 (95% CI 1.05-3.07). Differences in myocardial infarction, stroke, bleeding, and target lesion revascularization were not statistically significant.
Key findings
- Short-term DAPT was associated with higher MACE risk than long-term DAPT (RR 1.79; 95% CI 1.05-3.07).
- Short-term DAPT was associated with higher all-cause mortality (RR: 2.78; 95% CI: 1.49-5.19) and cardiac death (RR 2.29; 95% CI 1.34-3.91).
- Stent thrombosis was more frequent with short-term DAPT (RR: 4.90; 95% CI: 2.78-8.66).
- Differences in myocardial infarction, stroke, bleeding, and target lesion revascularization did not reach statistical significance.
Why it matters
Bifurcation PCI is a high-risk setting in which the appropriate DAPT duration is uncertain. These pooled findings indicate that shorter therapy may be associated with worse ischemic outcomes, including stent thrombosis and mortality. The absence of statistically significant differences in bleeding and other outcomes means the balance of ischemic and bleeding risks remains important when interpreting the results.
What to keep in mind
The meta-analysis included six studies, and the abstract does not specify whether treatment duration was randomized; the reported associations therefore should not be interpreted as proof that shorter DAPT caused worse outcomes.