Compared with short-term dual antiplatelet therapy (DAPT), long-term DAPT did not lower the risk of major adverse cardiac events but increased the risk of bleeding among patients with stents with or without diabetes, according to a study published in The BMJ.
A team of researchers aimed to compare clinical outcomes between short-term (up to 6 months) and long-term (12 months) DAPT following drug eluting stent placement in patients with and without diabetes. They searched various databases and proceedings of international meetings to identify randomized controlled trials comparing DAPT durations after drug eluting stent placement. The primary study outcomes was 1-year risk of major adverse cardiac events, which was defined as cardiac death, myocardial infarction, or definite/probable stent thrombosis.
Data was pooled from six DAPT studies that included 11,473 randomized patients. Of the total patients, 32.1% (n=3,681) had diabetes and 67.2% (n=7,708) did not; information was missing for 0.7% (n=84) of patients.
Diabetes was an independent predictor of major adverse cardiac events (hazard ratio [HR] 2.3, 95% CI: 1.01–5.27; P=0.048). By 1-year follow-up, long-term DAPT was not associated with a reduced risk of major adverse cardiac events compared with short-term DAPT in patients with (HR 1.05; P=0.86) or without (HR 0.97; P=0.85) diabetes.
Further, the risk of myocardial infarction did not vary between short-term vs. long-term DAPT (HR 0.95; P=0.82 [diabetes] vs. HR 1.15; P=0.60 [no diabetes]). The authors also noted a lower risk of definite/probable stent thrombosis with long-term DAPT among patients with diabetes (HR 0.26; p=0.02) than patients without diabetes (HR 1.42; P=0.35) although data from the landmark analysis indicated a beneficial trend for both groups. The data further indicated long-term DAPT was associated with higher rates of major or minor bleeding with or without diabetes (P=0.37).
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