The purpose of the study was to evaluate the optimal duration of dual antiplatelet
therapy (
DAPT) after
percutaneous coronary intervention, especially in the era of second-generation
drug-eluting stents (DES). The work was conducted from November 2014 to April 2015. All randomized controlled trials comparing short (<12 months) versus long (≥12 months)
DAPT in patients treated with second-generation DES were analyzed. Sensitivity analyses were performed for length of
DAPT and type of DES. All-cause death was the primary end point, whereas cardiovascular death,
myocardial infarction (MI),
stent thrombosis (ST), and major
bleeding were secondary end points. Results were pooled and compared with random-effect models and meta-regression analysis. Eight randomized controlled trials with 18,810 randomized patients were included. The studies compared 3 versus 12 months of
DAPT (2 trials), 6 versus 12 months (3 trials), 6 versus 24 months (1 trial), 12 versus 24 months (1 trial), and 12 versus 30 months (1 trial). Comparing short versus long
DAPT, there were no significant differences in all-cause death (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.66 to 1.44), cardiovascular death (OR 0.95; 95% CI 0.65 to 1.37), and ST (OR 1.20; 95% CI 0.79 to 1.83), and no differences were present when considering
everolimus-eluting and fast-release
zotarolimus-eluting
stents separately. Shorter
DAPT was inferior to longer
DAPT in preventing MI (OR 1.35; 95% CI 1.03 to 1.77). Conversely, major
bleeding was reduced by shorter
DAPT (OR 0.60; 95% CI 0.42 to 0.96). Baseline features did not influence these results in meta-regression analysis. In conclusion,
DAPT for ≤6 months is reasonable for patients treated with
everolimus-eluting and fast-release
zotarolimus-eluting
stents, with the benefit of less major
bleeding at the cost of increased MI, with similar survival and ST rates. An individualized patient approach to
DAPT duration should take into account the competing risks of
bleeding and ischemic complications after present-generation DES.