Review Article

Benefits and Harms of Extending the Duration of Dual Antiplatelet Therapy after Percutaneous Coronary Intervention with Drug-Eluting Stents: A Meta-Analysis

Table 1

Study design, duration of dual antiplatelet therapy, follow-up, and outcomes evaluated.

Study IDDesign; year of study; countryDefinition of short and long durationTotal number in short duration groupTotal number in longer duration groupFollow-up durationOutcomes evaluated

Gwon et al. 2012 (EXCELLENT trial) [6]Open-label RCT; June 2008–July 2009; South Korea.Short: 6 months. Long: 12 months.7227211 year after index PCI.Primary: target vessel failure—composite of cardiac death, myocardial infarction, or target vessel revascularization.
Secondary: death from any cause; death or myocardial infarction; stent thrombosis; major bleeding; major adverse cardiocerebral events—composite of death, myocardial infarction, cerebrovascular accident, or any revascularization; safety endpoint—composite of death, myocardial infarction, cerebrovascular accident, stent thrombosis, or thrombolysis In myocardial infarction major bleeding.

Hu and Wang 2012 [10]Double-blind RCT; September 2008–October 2011; China.Short: 12 months.
Long: >36 months.
88943 years after PCI.Primary (12 months onwards): target vessel failure, defined as target vessel-related cardiac death or myocardial infarction and target vessel revascularization.
Secondary outcomes included stent thrombosis.

Kim et al. 2012 (RESET trial) [7]Open-label RCT; April 2009–December 2010; South Korea.Short: 3 months.
Long: 12 months.
1,0591,0581 year.Primary: cardiovascular death, myocardial infarction, stent thrombosis, ischemia driven target vessel revascularization, bleeding.
Secondary: individual components of primary endpoint plus nontarget vessel revascularization, cerebrovascular accident.

Park et al. 2010 (REAL-LATE and ZEST-LATE) [8]Open-label RCT; July 2007–September 2008; South Korea.Short: 12 months.
Long: 24 months.
1,3441,357Median duration of follow-up 19.2 months after randomization.Primary: (12 months onwards) myocardial infarction or death from cardiac causes.
Secondary: death from any cause; myocardial infarction; cerebrovascular accident; stent thrombosis; repeated revascularization; a composite of myocardial infarction or death from any cause; a composite of myocardial infarction, cerebrovascular accident, or death from any cause; a composite of myocardial infarction, cerebrovascular accident, or death from cardiac causes; and major bleeding.

Valgimigli et al. 2012 (PRODIGY) [9]Open-label RCT; December 2006–December 2008; Italy.Short: 6 months.
Long: 24 months.
9839872 years.Primary: 30-day to 24-month incidence of death from any cause, nonfatal myocardial infarction, or cerebrovascular accident.
Secondary: each component of primary outcome, cardiovascular death, the incidence of stent thrombosis, and bleeding outcomes.