Ticagrelor Monotherapy Following Short-Term DAPT in ACS Undergoing PCI: A Systematic Review and Meta-Analysis

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2025-02-26 DOI:10.1002/ccd.31459

Rocio Barriga Guzman, Manuel Villegas Roberson, Larissa Teixeira, Denilsa D. P. Navalha, Armando Talavera, Muhammad Ahmad, Yiannis Chatzizisis, Nikolaos Spilias

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Abstract

Background

Dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is the standard of care. However, it is associated with a higher incidence of bleeding events. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of short-term DAPT.

Aims

This study aimed to assess the relative risk of major and minor bleeding, net adverse clinical and cerebral events (NACCE), and all-cause mortality in patients with ACS undergoing PCI with DES, comparing ticagrelor-based short-term DAPT (≤ 3 months) followed by ticagrelor monotherapy for up to 12 months versus 12-month DAPT. The secondary endpoint evaluated the relative risk of complications, including myocardial infarction, stroke, stent thrombosis, repeat revascularization, and cardiovascular mortality.

Methods

A systematic search of PubMed, Scopus, and Cochrane Central was conducted for eligible RCTs. A subgroup analysis of ultrashort-term DAPT (≤ 1 month) followed by ticagrelor monotherapy for up to 12 months was also performed. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results

Five RCTs were included with a total of 21,407 patients. Short-term DAPT was associated with a significant reduction in major bleeding (RR 0.50; 95% CI 0.38−0.66; p < 0.01), minor bleeding (RR 0.53; 95% CI 0.35−0.80; p < 0.01), NACCE (RR 0.71; 95% CI 0.59−0.85; p < 0.01), and all-cause mortality (RR 0.78; 95% CI 0.62−0.98; p =0.04).

Conclusions

Short-term DAPT followed by ticagrelor monotherapy up to 12 months was associated with a significant reduction in major and minor bleeding, NACCE, and all-cause mortality compared to 12-month DAPT. There were no significant differences in myocardial infarction, stroke, stent thrombosis, repeat revascularization, or cardiovascular mortality. Major bleeding and NACCE remained consistently reduced in the subgroup analysis.

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替格瑞洛单药治疗ACS行PCI术后短期DAPT：系统回顾和荟萃分析。

背景：经皮冠状动脉介入治疗（PCI）药物洗脱支架（DES）患者急性冠脉综合征（ACS）后1年的双重抗血小板治疗（DAPT）是标准的护理。然而，它与出血事件的发生率较高有关。我们对随机对照试验（rct）进行了系统回顾和荟萃分析，以评估短期DAPT的安全性和有效性。目的：本研究旨在评估ACS患者行PCI + DES的大出血和轻微出血的相对风险、净不良临床和脑事件（NACCE）和全因死亡率，比较以替格瑞洛为基础的短期DAPT（≤3个月）与替格瑞洛单药治疗长达12个月的DAPT。次要终点评估并发症的相对风险，包括心肌梗死、卒中、支架血栓形成、重复血运重建术和心血管死亡率。方法：系统检索PubMed、Scopus和Cochrane Central中符合条件的随机对照试验。超短期DAPT（≤1个月）与替格瑞洛单药治疗长达12个月的亚组分析也进行了。采用随机效应模型计算95%置信区间（ci）的风险比（rr）。结果：纳入5项随机对照试验，共21,407例患者。短期DAPT与大出血的显著减少相关(RR 0.50；95% ci 0.38-0.66；结论：与12个月的DAPT相比，短期DAPT与替格瑞洛单药治疗后12个月的大出血和小出血、NACCE和全因死亡率显著降低相关。两组在心肌梗死、卒中、支架血栓形成、重复血运重建术或心血管死亡率方面无显著差异。在亚组分析中，大出血和NACCE持续减少。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.

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