Non-inferiority of 1 month versus longer dual antiplatelet therapy in patients undergoing PCI with drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials.

The aim of this meta-analysis was to evaluate the safety of 1-month dual antiplatelet therapy (DAPT) followed by aspirin or a P2Y12 receptor inhibitor, after percutaneous coronary intervention (PCI) with drug-eluting stents (DES), based on the available evidence. PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL, and ClinicalTrials.gov database search identified four RCTs of 26,431 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary endpoint was major bleeding and co-primary endpoint stent thrombosis, and secondary endpoints included all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke, and major adverse clinical events (MACE). Compared with >1-month DAPT, the 1-month DAPT was associated with a similar rate of major bleeding (OR = 0.74, 95%CI: 0.51-1.07, p = 0.11, I 2 = 67%), stent thrombosis (OR = 1.10, 95%CI: 0.82-1.47, p = 0.53, I 2 = 0.0%), similar risk for all-cause mortality (OR = 0.89, 95%CI: 0.77-1.04, p = 0.14, I 2 = 0%), CV death (OR = 0.80, 95% CI: 0.55-1.60, p = 0.24, I 2 = 0.0%), MI (OR = 1.02, 95% CI: 0.88-1.19, p = 0.78, I 2 = 0.0%), and stroke (OR = 0.76, 95% CI: 0.54-1.08, p = 0.13, I 2 = 29%). The risk of MACE was lower (OR = 0.84, 95% CI: 0.73-0.98, p = 0.02, I 2 = 39%) in the 1-month DAPT compared with the >1-month DAPT. Only patients with stable CAD had lower risk of MACE with 1-month DAPT (OR = 0.81, 95% CI: 0.67-0.98, p = 0.03, I 2 = 21%) compared with >1-month DAPT. This meta-analysis proved the non-inferiority of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor compared with long-term DAPT in patients undergoing PCI with DES.