Introduction. This network meta-analysis aimed to evaluate the efficacy and safety of different dual antiplatelet therapies (DAPTs) after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). Methods. Randomized controlled trials (RCTs) comparing longer-term (>12 months) DAPT (L-DAPT), 12-month DAPT (DAPT 12Mo), 6-month DAPT (DAPT 6Mo), 3-month DAPT followed by aspirin monotherapy (DAPT 3Mo + ASA), 3-month DAPT followed by a P2Y12 receptor inhibitor monotherapy (DAPT 3Mo + P2Y12), or 1-month DAPT with a P2Y12 receptor inhibitor monotherapy (DAPT 1Mo + P2Y12) were searched. Primary endpoints were all-cause mortality, cardiac death, myocardial infarction (MI), major bleeding, any bleeding, definite or probable stent thrombosis (ST), and net adverse clinical events (NACE). This Bayesian network meta-analysis was performed with the random-effects model. Results. Twenty-four RCTs (n = 81339) were included. In comparison with L-DAPT, DAPT 6Mo (OR: 0.50, 95% CI: 0.29–0.83), DAPT 3Mo + P2Y12 (OR: 0.38, 95% CI: 0.18–0.82), DAPT 3Mo + ASA (OR: 0.44, 95% CI: 0.17–0.98), and DAPT 1Mo + P2Y12 (OR: 0.45, 95% CI: 0.14–0.93) were associated with a lower risk of major bleeding. DAPT 3Mo + P2Y12 (OR: 0.58, 95% CI: 0.38–0.88) reduced the risk of any bleeding when compared with DAPT 12Mo. L-DAPT decreased the risk of MI and definite or probable stent ST when compared with DAPT 6Mo. DAPT 3Mo + P2Y12 decreased the risk of NACE in comparison with DAPT 6Mo and DAPT 12Mo. No significant difference in all-cause mortality and cardiac death was observed. In patients with acute coronary syndrome, DAPT 6Mo was comparable to DAPT 12Mo. Conclusion. Short-term (1–3 months) DAPT is noninferior to DAPT 6Mo after DESs implantation, while L-DAPT reduces MI and definite or probable ST rates. DAPT 3Mo + P2Y12 might be a reasonable trade-off in patients with high risk of bleeding accompanied by ischemia.

中文翻译：

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双重抗血小板治疗对冠状动脉支架植入患者的疗效和安全性：系统评价和网络Meta分析

引言。该网络荟萃分析旨在评估使用药物洗脱支架（DES）进行的经皮冠状动脉介入治疗（PCI）后不同双重抗血小板治疗（DAPT）的疗效和安全性。方法。比较长期（> 12个月）DAPT（L-DAPT），12个月DAPT（DAPT 12Mo），6个月DAPT（DAPT 6Mo），3个月DAPT和阿司匹林单药治疗（DAPT）的随机对照试验（RCT）搜索3Mo + ASA），3个月DAPT，然后进行P2Y12受体抑制剂单药治疗（DAPT 3Mo + P2Y12）或1个月DAPT，并进行P2Y12受体抑制剂单药治疗（DAPT 1Mo + P2Y12）。主要终点为全因死亡率，心源性死亡，心肌梗塞（MI），大出血，任何出血，明确或可能的支架血栓形成（ST）以及净不良临床事件（NACE）。该贝叶斯网络的荟萃分析是使用随机效应模型进行的。结果。24个RCT（n = 81339）。与L-DAPT相比，DAPT 6Mo（OR：0.50，95％CI：0.29–0.83），DAPT 3Mo + P2Y12（OR：0.38，95％CI：0.18–0.82），DAPT 3Mo + ASA（OR：0.44， 95％CI：0.17-0.98）和DAPT 1Mo + P2Y12（OR：0.45，95％CI：0.14-0.93）与较低的大出血风险相关。与DAPT 12Mo相比，DAPT 3Mo + P2Y12（OR：0.58，95％CI：0.38–0.88）降低了出血的风险。与DAPT 6Mo相比，L-DAPT降低了MI以及明确或可能的支架ST的风险。与DAPT 6Mo和DAPT 12Mo相比，DAPT 3Mo + P2Y12降低了NACE的风险。在全因死亡率和心源性死亡方面未观察到显着差异。在急性冠脉综合征患者中，DAPT 6Mo与DAPT 12Mo相当。结论。DES植入后短期（1-3个月）DAPT不逊于DAPT 6Mo，而L-DAPT可以降低MI和确定的或可能的ST发生率。DAPT 3Mo + P2Y12在高出血风险并伴有缺血的患者中可能是一个合理的权衡。