Three versus 12‐month dual antiplatelet therapy duration in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials

Introduction The American Heart Association/American College of Cardiology guidelines on dual antiplatelet therapy (DAPT) recommend at least 12 months of a P2Y12 inhibitor and low dose aspirin in patients with an acute coronary syndrome (ACS) treated with a stent. Since that recommendation, several randomized controlled trials (RCTs) have studied an abbreviated duration of DAPT in ACS. Therefore, we sought to perform a meta‐analysis of RCTs comparing 3‐ versus 12‐month DAPT in patients presenting with ACS undergoing percutaneous coronary intervention (PCI). Methods PubMed, Embase, and Cochrane Central databases were searched until July 31, 2022, for RCTs comparing 3‐ versus 12‐month DAPT in patients with ACS undergoing PCI. Outcomes assessed were major adverse cardiovascular events (MACE), cardiovascular mortality, all‐cause mortality, myocardial infarction (MI), stent thrombosis (ST) and bleeding. A random‐effects model was used to calculate pooled relative risk (RR) and 95% confidence intervals (CI). Results We included 5 trials comprising 16,781 patients with an ACS that underwent PCI. There was no significant difference in MACE (RR: 0.92; 95% CI: 0.76–1.11), cardiovascular mortality (RR: 1.26; 95% CI: 0.38–4.17), or all‐cause mortality (RR: 0.92; 95% CI: 0.48–1.77) between the 2 groups. In addition, there was no difference in rates of MI (RR: 0.98; 95% CI: 0.74–1.30), or ST (RR: 1.30; 95% CI: 0.55–3.05) between 3‐ and 12‐month DAPT. However, compared with 12‐month DAPT, 3‐month DAPT significantly reduced risk of major bleeding (RR: 0.53; 95% CI: 0.43–0.64). Conclusions In patients with ACS undergoing PCI, 3‐month DAPT reduced risk of bleeding without evidence of harm.