Meta-analysis finds extended DAPT related to increased mortality after DES implantation

(Press-News.org) NEW YORK, NY - March 13, 2015 - Data from a meta-analysis published today in The Lancet found that extended duration dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation was associated with significantly higher rates of mortality compared to shorter DAPT.

The optimal duration of DAPT has been a matter of debate since the introduction of DES. A meta-analysis using multiple analytical approaches to investigate mortality and other clinical outcomes with different DAPT strategies was conducted.

Researchers examined 31,666 patients from 10 randomized trials comparing different durations of DAPT in patients treated with DES. The primary endpoint was all-cause mortality. Secondary pre-specified endpoints included cardiac death, non-cardiac death, myocardial infarction (MI), stroke, stent thrombosis (definite or probable), major bleeding, and any bleeding. DAPT duration was categorized in each study as "shorter" vs. "longer," and ?6 months vs. 1 year vs. ?1 year. Analyses were performed by both frequentist and Bayesian approaches.

Shorter DAPT was associated with significantly lower rates of all-cause mortality compared to longer DAPT (HR=0.82, 95% CI 0.69-0.98, p=0.02; number needed to treat [NNT] =325). This difference was driven by a significant reduction of non-cardiac mortality with shorter DAPT (HR=0.67, 95% CI 0.51-0.89, p=0.006; NNT=347). No significant difference in cardiac mortality was found between the shorter and longer strategies (HR=0.93, 95% CI 0.73-1.17, p=0.52). No significant heterogeneity across trials or between pooled trials stratified by DAPT duration was apparent.

Shorter DAPT was also associated with significantly lower rates of major bleeding (HR=0.58, 95% CI 0.47-0.72, p END