Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis

Tullio Palmerini; Diego Sangiorgi; Marco Valgimigli; Giuseppe Biondi-Zoccai; Fausto Feres; Alexandre Abizaid; Ricardo A. Costa; Myeong Ki Hong; Byeong Keuk Kim; Yangsoo Jang; Hyo Soo Kim; Kyung Woo Park; Andrea Mariani; Diego Della Riva; Philippe Genereux; Martin B. Leon; Deepak L. Bhatt; Umberto Bendetto; Claudio Rapezzi; Gregg W. Stone

doi:10.1016/j.jacc.2014.12.046

Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis

Tullio Palmerini, Diego Sangiorgi, Marco Valgimigli, Giuseppe Biondi-Zoccai, Fausto Feres, Alexandre Abizaid, Ricardo A. Costa, Myeong Ki Hong, Byeong Keuk Kim, Yangsoo Jang, Hyo Soo Kim, Kyung Woo Park, Andrea Mariani, Diego Della Riva, Philippe Genereux, Martin B. Leon, Deepak L. Bhatt, Umberto Bendetto, Claudio Rapezzi, Gregg W. Stone

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

171 Citations (Scopus)

Abstract

Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

Original language	English
Pages (from-to)	1092-1102
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	65
Issue number	11
DOIs	https://doi.org/10.1016/j.jacc.2014.12.046
Publication status	Published - 2015 Mar 24

Bibliographical note

Funding Information:
No sponsor of any of the individual trials had any role in the study design, data collection, data interpretation, or drafting of the manuscript. Medtronic provided the data from the OPTIMIZE trial. Dr. Palmerini has received a speaker fee from Abbott Vascular; and a research grant from Eli Lilly . Dr. Valgimigli has received speaker or consultant fees from Abbott Vascular, AstraZeneca, Alvimedica, Medtronic, Terumo, and The Medicines Company. Dr. Biondi-Zoccai was, at the time of the preparation of this manuscript, the Congdon Visiting Scholar at the VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; he has consulted for Bayer Pharma and Novartis; has lectured for Abbott Vascular, AstraZeneca, DirectFlow Medical, and St. Jude Medical; and has received career grant support from Medtronic . Dr. Feres has received speaker fees from Biosensors and Eli Lilly; and has been a consultant for Medtronic and Scitech. Dr. Genereux has received speaker fees from Abbott and Cardiovascular System Inc. Dr. Bhatt is on the advisory board of Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is on the Board of Directors of Boston VA Research Institute and the Society of Cardiovascular Patient Care; is Chair of the American Heart Association Get With The Guidelines Steering Committee; is on the Data Monitoring Committees at Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and Population Health Research Institute; has received honoraria from the American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), and WebMD (CME steering committees); is the Deputy Editor of Clinical Cardiology; is the Section Editor for pharmacology for the Journal of the American College of Cardiology; has received research grants from Amarin , AstraZeneca , Bristol-Myers Squibb , Eisai , Ethicon , Medtronic , Roche , Sanofi , and The Medicines Company ; and has received unfunded research from FlowCo, PLx Pharma, and Takeda. Dr. Stone has served as a consultant for Boston Scientific, Eli Lilly, Daiichi-Sankyo, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2015 American College of Cardiology Foundation.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2014.12.046

Cite this

Palmerini, T., Sangiorgi, D., Valgimigli, M., Biondi-Zoccai, G., Feres, F., Abizaid, A., Costa, R. A., Hong, M. K., Kim, B. K., Jang, Y., Kim, H. S., Park, K. W., Mariani, A., Della Riva, D., Genereux, P., Leon, M. B., Bhatt, D. L., Bendetto, U., Rapezzi, C., & Stone, G. W. (2015). Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis. Journal of the American College of Cardiology, 65(11), 1092-1102. https://doi.org/10.1016/j.jacc.2014.12.046

@article{4f435e328dbe4210a443bb5c30a1d743,

title = "Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis",

abstract = "Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.",

author = "Tullio Palmerini and Diego Sangiorgi and Marco Valgimigli and Giuseppe Biondi-Zoccai and Fausto Feres and Alexandre Abizaid and Costa, {Ricardo A.} and Hong, {Myeong Ki} and Kim, {Byeong Keuk} and Yangsoo Jang and Kim, {Hyo Soo} and Park, {Kyung Woo} and Andrea Mariani and {Della Riva}, Diego and Philippe Genereux and Leon, {Martin B.} and Bhatt, {Deepak L.} and Umberto Bendetto and Claudio Rapezzi and Stone, {Gregg W.}",

note = "Funding Information: No sponsor of any of the individual trials had any role in the study design, data collection, data interpretation, or drafting of the manuscript. Medtronic provided the data from the OPTIMIZE trial. Dr. Palmerini has received a speaker fee from Abbott Vascular; and a research grant from Eli Lilly . Dr. Valgimigli has received speaker or consultant fees from Abbott Vascular, AstraZeneca, Alvimedica, Medtronic, Terumo, and The Medicines Company. Dr. Biondi-Zoccai was, at the time of the preparation of this manuscript, the Congdon Visiting Scholar at the VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; he has consulted for Bayer Pharma and Novartis; has lectured for Abbott Vascular, AstraZeneca, DirectFlow Medical, and St. Jude Medical; and has received career grant support from Medtronic . Dr. Feres has received speaker fees from Biosensors and Eli Lilly; and has been a consultant for Medtronic and Scitech. Dr. Genereux has received speaker fees from Abbott and Cardiovascular System Inc. Dr. Bhatt is on the advisory board of Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is on the Board of Directors of Boston VA Research Institute and the Society of Cardiovascular Patient Care; is Chair of the American Heart Association Get With The Guidelines Steering Committee; is on the Data Monitoring Committees at Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and Population Health Research Institute; has received honoraria from the American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today{\textquoteright}s Intervention), and WebMD (CME steering committees); is the Deputy Editor of Clinical Cardiology; is the Section Editor for pharmacology for the Journal of the American College of Cardiology; has received research grants from Amarin , AstraZeneca , Bristol-Myers Squibb , Eisai , Ethicon , Medtronic , Roche , Sanofi , and The Medicines Company ; and has received unfunded research from FlowCo, PLx Pharma, and Takeda. Dr. Stone has served as a consultant for Boston Scientific, Eli Lilly, Daiichi-Sankyo, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2015 American College of Cardiology Foundation.",

year = "2015",

month = mar,

day = "24",

doi = "10.1016/j.jacc.2014.12.046",

language = "English",

volume = "65",

pages = "1092--1102",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "11",

}

Palmerini, T, Sangiorgi, D, Valgimigli, M, Biondi-Zoccai, G, Feres, F, Abizaid, A, Costa, RA, Hong, MK, Kim, BK, Jang, Y, Kim, HS, Park, KW, Mariani, A, Della Riva, D, Genereux, P, Leon, MB, Bhatt, DL, Bendetto, U, Rapezzi, C & Stone, GW 2015, 'Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis', Journal of the American College of Cardiology, vol. 65, no. 11, pp. 1092-1102. https://doi.org/10.1016/j.jacc.2014.12.046

Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis. / Palmerini, Tullio; Sangiorgi, Diego; Valgimigli, Marco et al.
In: Journal of the American College of Cardiology, Vol. 65, No. 11, 24.03.2015, p. 1092-1102.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation

T2 - An individual patient data pairwise and network meta-analysis

AU - Palmerini, Tullio

AU - Sangiorgi, Diego

AU - Valgimigli, Marco

AU - Biondi-Zoccai, Giuseppe

AU - Feres, Fausto

AU - Abizaid, Alexandre

AU - Costa, Ricardo A.

AU - Hong, Myeong Ki

AU - Kim, Byeong Keuk

AU - Jang, Yangsoo

AU - Kim, Hyo Soo

AU - Park, Kyung Woo

AU - Mariani, Andrea

AU - Della Riva, Diego

AU - Genereux, Philippe

AU - Leon, Martin B.

AU - Bhatt, Deepak L.

AU - Bendetto, Umberto

AU - Rapezzi, Claudio

AU - Stone, Gregg W.

N1 - Funding Information: No sponsor of any of the individual trials had any role in the study design, data collection, data interpretation, or drafting of the manuscript. Medtronic provided the data from the OPTIMIZE trial. Dr. Palmerini has received a speaker fee from Abbott Vascular; and a research grant from Eli Lilly . Dr. Valgimigli has received speaker or consultant fees from Abbott Vascular, AstraZeneca, Alvimedica, Medtronic, Terumo, and The Medicines Company. Dr. Biondi-Zoccai was, at the time of the preparation of this manuscript, the Congdon Visiting Scholar at the VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; he has consulted for Bayer Pharma and Novartis; has lectured for Abbott Vascular, AstraZeneca, DirectFlow Medical, and St. Jude Medical; and has received career grant support from Medtronic . Dr. Feres has received speaker fees from Biosensors and Eli Lilly; and has been a consultant for Medtronic and Scitech. Dr. Genereux has received speaker fees from Abbott and Cardiovascular System Inc. Dr. Bhatt is on the advisory board of Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is on the Board of Directors of Boston VA Research Institute and the Society of Cardiovascular Patient Care; is Chair of the American Heart Association Get With The Guidelines Steering Committee; is on the Data Monitoring Committees at Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and Population Health Research Institute; has received honoraria from the American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), and WebMD (CME steering committees); is the Deputy Editor of Clinical Cardiology; is the Section Editor for pharmacology for the Journal of the American College of Cardiology; has received research grants from Amarin , AstraZeneca , Bristol-Myers Squibb , Eisai , Ethicon , Medtronic , Roche , Sanofi , and The Medicines Company ; and has received unfunded research from FlowCo, PLx Pharma, and Takeda. Dr. Stone has served as a consultant for Boston Scientific, Eli Lilly, Daiichi-Sankyo, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2015 American College of Cardiology Foundation.

PY - 2015/3/24

Y1 - 2015/3/24

N2 - Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

AB - Background Randomized controlled trials comparing short- (≤6 months) with long-term (≥1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (≤6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement.

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Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis

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