Coronary disease & ACSMeta-analysis
Optimal timing of aspirin discontinuation after acute coronary syndrome treated with percutaneous coronary intervention: a systematic review and meta-analysis
- pairwise and network meta-analyses (NMAs)
Authors' conclusion
In patients with ACS undergoing PCI, short DAPT followed by P2Y 12 inhibitor monotherapy is superior to standard DAPT with respect to NACE. Although a brief period of DAPT appears warranted after ACS, the optimal timing of aspirin discontinuation remains uncertain. While earlier aspirin discontinuation may be associated with greater net clinical benefit owing to reduced bleeding, 3-month DAPT may be associated with more favourable ischaemic outcomes, underscoring the importance of individualising DAPT duration according to bleeding and ischaemic risk.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI)
- Participants
- 34,283 patients · 11 trials
- Comparison
- short dual antiplatelet therapy (DAPT) followed by P2Y 12 inhibitor monotherapy with 12-month DAPT
- Outcome
- study-defined net adverse clinical events (NACE), a composite of ischaemic and bleeding outcomes
Pooled result
As reported in the abstract
Relative risk
0.77
95% CI 0.66–0.89
Further pooled results
Major adverse cardiovascular events (MACE)
- No significant difference in MACE was observed among DAPT strategies
- 3-month DAPT consistently ranked highest for MACE and for individual ischaemic endpoints
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| major bleeding | 0.46 (0.36–0.58) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Summarised from the published abstract; every number is checked against it