Short duration of dual antiplatelet therapy following complex percutaneous coronary intervention: A systematic review and meta-analysis

Introduction and aim: The optimal composition and duration of antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We conducted a meta-analysis to compare 1–3 months of dual antiplatelet therapy (DAPT) followed by monotherapy vs. 12 months of DAPT. Method: MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing 1–3 months of DAPT followed by monotherapy vs. 12 months of DAPT in the outcomes of complex PCI from inception through January 2023. Outcomes of interest included major bleeding, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stent thrombosis, target vessel revascularization, and stroke. Results: Compared to 12 months, 1–3 months of dual antiplatelet therapy had a weak association with less major bleeding (OR 0.67; 95 % CI, 0.44–1.00; p = 0.05; I² = 28 %). There were no significant differences between the shorter and longer antiplatelet therapy in terms of all-cause mortality (OR 0.83; 95 % CI, 0.59–1.16; p = 0.21; I² = 17 %), cardiovascular mortality (OR 0.87; 95 % CI, 0.53–0.42; p = 0.50; I² = 0), MI (OR 0.97; 95 % CI, 0.69–1.35; p = 0.82; I² = 32 %), stent thrombosis (OR 1.17, 95 % CI, 0.77–1.76; p = 0.38; I² = 0 %), target vessel revascularization (OR 1.05, 95 % CI, 0.58–1.89; p = 0.82; I² = 64 %), or stroke (OR 1.10, 95 % CI, 0.55–2.17; p = 0.37; I² = 7 %);. Conclusion: Among patients undergoing complex PCI, DAPT for 1–3 months may be associated with less major bleeding but similar rates of cardiovascular events (death, MI, stroke, stent thrombosis, and revascularization) compared to DAPT for 12 months.