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OPTIMAL DURATION OF DUAL ANTIPLATELET THERAPY AMONG PATIENTS UNDERGOING DRUG ELUTING STENT PLACEMENT: A BAYESIAN NETWORK META-ANALYSIS
541 JACC April 5, 2016 Volume 67, Issue 13
Acute Coronary Syndromes OPTIMAL DURATION OF DUAL ANTIPLATELET THERAPY AMONG PATIENTS UNDERGOING DRUG ELUTING STENT PLACEMENT: A BAYESIAN NETWORK META-ANALYSIS Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Acute Coronary Syndromes: Managing Dilemmas in Antithrombotic Therapy Abstract Category: 15. Acute Coronary Syndromes: Therapy Presentation Number: 1133-021 Authors: Ravi Parikh, Harsh Golwala, Sushil Garg, Ambarish Pandey, Abdallah El Sabbagh, Christopher DeFilippi, University of Maryland Medical Center, Baltimore, MD, USA
Background: The optimal duration of dual antiplatelet therapy (DAPT) among patients undergoing drug-eluting coronary stent placement is not well established. We evaluated the contemporary literature to determine the comparative efficacy and safety of different durations of DAPT in this patient population.
Methods: We performed a Bayesian network meta-analysis of randomized controlled trials that compared different DAPT durations among patients who received drug-eluding stents. The primary efficacy outcomes were risk of cardiovascular (CV) mortality and myocardial infarction (MI) while the primary safety outcome was risk of major bleeding.
Results: A total of 10 studies enrolling a total of 42,195 patients were included in the analysis. The Table contains hazard ratios and 95% confidence intervals of the outcomes with each row containing the reference treatment duration. Shorter duration DAPT regimens (< 12 months) were associated with higher risk of CV mortality and MI as compared with extended duration DAPT (> 12 months). Among different DAPT duration regimens, 24 to 30-month therapy was associated with lowest risk CV mortality and MI as compared with other treatment arms. The risk of major bleeding was not statistically significant across different DAPT durations. Conclusions: Extended duration DAPT for 24-30 months is associated with lower risk of adverse cardiovascular events and comparable risk for major bleeding events when compared with shorter duration therapy. Table: CV mortality 3 months 1.2 (0.5,2.9) 2.6 (1.2,5.3) 2.9 (1.2,7.5) 5.3 (1.9,15.1) 1.9 (0.5,7.0) Myocardial infarction 3 months 1.2 (0.5, 2.8) 2.6 (1.3,5.2) 3.0 (1.2,7.1) 5.4 (2.0,14.7) 2.0 (0.6,7.0)
0.9 (0.3,2.2) 6 months 2.2 (1.3,3.7) 2.5 (1.4,4.4) 4.6 (1.9,11.3) 1.7 (0.5,5.3)
0.4 (0.2,0.8) 0.5 (0.3,0.8) 12 months 1.2 (0.7,2.0) 2.1 (1.0,4.4) 0.8 (0.3,2.2)
0.3 (0.1,0.9) 0.4 (0.2,0.7) 0.9 (0.5,1.5) 24 months 1.8 (0.7,4.6) 0.7 (0.2,2.2)
0.2 (0.1,0.5) 0.2 (0.1,0.5) 0.5 (0.2,1.0) 0.6 (0.2,1.4) 30 months 0.4 (0.1,1.3)
0.5 (0.1,1.9) 0.6 (0.2,1.9) 1.3 (0.5,3.8) 1.5 (0.5,5.0) 2.8 (0.8,10.0) 36 months
0.9 (0.4,2.1) 6 months 2.2 (1.4,3.6) 2.5 (1.5,4.3) 4.6 (2.0,10.8) 1.7 (0.6,5.2)
0.4 (0.2,0.8) 0.5, (0.3,0.7) 12 months 1.1 (0.7,1.9) 2.1 (1.0,4.2) 0.8 (0.3,2.1)
0.3 (0.1,0.8) 0.4 (0.2,0.7) 0.9 (0.5,1.5) 24 months 1.8 (0.8,4.4) 0.7 (0.2,2.1)
0.2 (0.1,0.5) 0.2 (0.1,0.5) 0.5 (0.2,0.97) 0.6 (0.2,1.3) 30 months 0.4 (0.1,1.3)
0.5 (0.1,1.8) 0.6 (0.2,1.8) 1.3 (0.5,3.6) 1.5 (0.5,4.7) 2.7 (0.8,9.4) 36 months
Acute Coronary Syndromes OPTIMAL DURATION OF DUAL ANTIPLATELET THERAPY AMONG PATIENTS UNDERGOING DRUG ELUTING STENT PLACEMENT: A BAYESIAN NETWORK META-ANALYSIS Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Acute Coronary Syndromes: Managing Dilemmas in Antithrombotic Therapy Abstract Category: 15. Acute Coronary Syndromes: Therapy Presentation Number: 1133-021 Authors: Ravi Parikh, Harsh Golwala, Sushil Garg, Ambarish Pandey, Abdallah El Sabbagh, Christopher DeFilippi, University of Maryland Medical Center, Baltimore, MD, USA
Background: The optimal duration of dual antiplatelet therapy (DAPT) among patients undergoing drug-eluting coronary stent placement is not well established. We evaluated the contemporary literature to determine the comparative efficacy and safety of different durations of DAPT in this patient population.
Methods: We performed a Bayesian network meta-analysis of randomized controlled trials that compared different DAPT durations among patients who received drug-eluding stents. The primary efficacy outcomes were risk of cardiovascular (CV) mortality and myocardial infarction (MI) while the primary safety outcome was risk of major bleeding.
Results: A total of 10 studies enrolling a total of 42,195 patients were included in the analysis. The Table contains hazard ratios and 95% confidence intervals of the outcomes with each row containing the reference treatment duration. Shorter duration DAPT regimens (< 12 months) were associated with higher risk of CV mortality and MI as compared with extended duration DAPT (> 12 months). Among different DAPT duration regimens, 24 to 30-month therapy was associated with lowest risk CV mortality and MI as compared with other treatment arms. The risk of major bleeding was not statistically significant across different DAPT durations. Conclusions: Extended duration DAPT for 24-30 months is associated with lower risk of adverse cardiovascular events and comparable risk for major bleeding events when compared with shorter duration therapy. Table: CV mortality 3 months 1.2 (0.5,2.9) 2.6 (1.2,5.3) 2.9 (1.2,7.5) 5.3 (1.9,15.1) 1.9 (0.5,7.0) Myocardial infarction 3 months 1.2 (0.5, 2.8) 2.6 (1.3,5.2) 3.0 (1.2,7.1) 5.4 (2.0,14.7) 2.0 (0.6,7.0)
0.9 (0.3,2.2) 6 months 2.2 (1.3,3.7) 2.5 (1.4,4.4) 4.6 (1.9,11.3) 1.7 (0.5,5.3)
0.4 (0.2,0.8) 0.5 (0.3,0.8) 12 months 1.2 (0.7,2.0) 2.1 (1.0,4.4) 0.8 (0.3,2.2)
0.3 (0.1,0.9) 0.4 (0.2,0.7) 0.9 (0.5,1.5) 24 months 1.8 (0.7,4.6) 0.7 (0.2,2.2)
0.2 (0.1,0.5) 0.2 (0.1,0.5) 0.5 (0.2,1.0) 0.6 (0.2,1.4) 30 months 0.4 (0.1,1.3)
0.5 (0.1,1.9) 0.6 (0.2,1.9) 1.3 (0.5,3.8) 1.5 (0.5,5.0) 2.8 (0.8,10.0) 36 months
0.9 (0.4,2.1) 6 months 2.2 (1.4,3.6) 2.5 (1.5,4.3) 4.6 (2.0,10.8) 1.7 (0.6,5.2)
0.4 (0.2,0.8) 0.5, (0.3,0.7) 12 months 1.1 (0.7,1.9) 2.1 (1.0,4.2) 0.8 (0.3,2.1)
0.3 (0.1,0.8) 0.4 (0.2,0.7) 0.9 (0.5,1.5) 24 months 1.8 (0.8,4.4) 0.7 (0.2,2.1)
0.2 (0.1,0.5) 0.2 (0.1,0.5) 0.5 (0.2,0.97) 0.6 (0.2,1.3) 30 months 0.4 (0.1,1.3)
0.5 (0.1,1.8) 0.6 (0.2,1.8) 1.3 (0.5,3.6) 1.5 (0.5,4.7) 2.7 (0.8,9.4) 36 months