高出血风险患者的双联抗血小板疗法持续时间和支架类型：系统综述和网络荟萃分析。

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2024-10-05 DOI:10.1016/j.ahj.2024.10.004

Tetsuya Saito MD , Toshiki Kuno MD, PhD , Tomohiro Fujisaki MD , Rahul Gupta MD , Kaveh Hosseini MD-MPH , Hisato Takagi MD, PhD , Jose Wiley MD, MPH , Sripal Bangalore MD, MHA

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引用次数: 0

摘要

背景：目前尚不确定双重抗血小板疗法（DAPT）在高出血风险（HBR）患者中的疗效和安全性是否会因DAPT持续时间和支架类型（如耐久性聚合物药物洗脱支架（DP-DES）、生物降解聚合物DES（BP-DES）或无聚合物药物涂层支架（PF-DCS））而有所不同。我们旨在研究适合 HBR 患者的支架类型和 DAPT 持续时间：方法：检索了 PubMed 和 EMBASE，检索期至 2023 年 10 月。方法：检索了截至 2023 年 10 月的 PubMed 和 RMBASE，其中涉及 HBR 患者的随机对照试验（RCT）比较了使用 DP 或 BP-DES 的标准 DAPT（6-12 个月）与使用 DP 或 BP-DES 或 PF-DCS 或裸金属支架（BMS）的短期 DAPT（≤3 个月）。主要疗效结果是主要心血管不良事件（MACE），定义为心血管死亡、心肌梗死（MI）和中风。主要安全性结果为大出血。次要结果包括心肌梗死和支架血栓形成（ST）。我们采用随机效应模型进行了网络荟萃分析：结果：共纳入了 13 项 RCT，共计 19,418 名 HBR 患者。与使用DP-DES的标准DAPT相比，使用BMS的短DAPT与更高的MACE和MI风险相关。在大出血方面，短程 DAPT 策略的风险低于标准 DAPT 策略（例如，使用 DP-DES 的短程 DAPT 与使用 DP-DES 的标准 DAPT 相比；HR[95% CI]：0.48[0.28-0.82]).有趣的是，使用 BP-DES 比使用 DP-DES 发生 ST 的风险更高（例如，使用 BP-DES 的标准 DAPT 与使用 DP-DES 的短 DAPT 相比；HR[95% CI]：2.65[1.03-6.79]）：结论：对于接受经皮冠状动脉介入治疗的 HBR 患者，应采用带 DP-DES 的短 DAPT 策略，因为它能提供最佳的疗效和安全性组合。

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Dual antiplatelet therapy duration and stent type in patients with high bleeding risk: A systematic review and network meta-analysis

Background

It is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (eg, durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)). We aimed to study the stent type and DAPT duration appropriate for patients with HBR.

Methods

PubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified. The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model.

Results

Thirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES vs standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES vs short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]).

Conclusions

In patients with HBR who underwent percutaneous coronary intervention, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety.

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.