Meta-analysis
Dual antiplatelet therapy de-escalation in acute coronary syndrome: an individual patient meta-analysis
- Individual patient data meta-analysis of randomised trials
Authors' conclusion
In this individual patient data meta-analysis, DAPT-based de-escalation was associated with both decreased ischaemic and bleeding endpoints. Reduction in bleeding endpoints was more prominent for the unguided than the guided de-escalation strategy.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI)
- Participants
- 10,133 patients · 4 randomised clinical trials (RCTs)
- Comparison
- Dual-antiplatelet therapy (DAPT) de-escalation vs standard DAPT
- Outcome
- Co-primary: ischaemic composite (cardiac death, MI, cerebrovascular events) and any bleeding
- Follow-up
- 1 year post-PCI
Pooled result
As reported in the abstract
Ischaemic composite:
- Cardiac death
- MI
- Cerebrovascular events
De-escalation vs Standard strategyHazard ratio (95% CI)P value
ischaemic endpoint; log rank P
0.761(0.597–0.972)
P = 0.029any bleeding (co-primary): 6.5% vs. 9.1%; log rank P
0.701(0.606–0.811)
P < 0.001Further pooled results
All-cause death and major bleeding
- No significant intergroup differences
Bleeding endpoint, unguided vs guided de-escalation (subgroup)
- Unguided de-escalation had a significantly larger impact on bleeding reduction than guided
- P for interaction = 0.007
- No intergroup differences for the ischaemic endpoints
Original publication
Dual antiplatelet therapy de-escalation in acute coronary syndrome: an individual patient meta-analysis. Eur Heart J. Published 8 March 2023. doi:10.1093/eurheartj/ehac829
Summarised from the published abstract; every number is checked against it