Optimum duration of dual antiplatelet therapy followed by monotherapy for diabetes after percutaneous coronary intervention with drug-eluting stent implantation: a Bayesian network meta-analysis.

Introduction The standard 12-month dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation that is recommend for the general population may not be suitable for diabetes patients. Objectives To evaluate the efficacy and safety of short-term (≤3 months), midterm (6 months), standard-term (12 months), and extended-term (>12 months) DAPT in diabetes patients with DES implantation. To compare discontinuation of DAPT followed by monotherapy with aspirin versus P2Y12 inhibitor. Patients and methods Randomized controlled trials were searched using PubMed, Web of Science, Embase, Cochrane library, and clinicaltrials.gov up to October 10, 2020. A Bayesian network meta-analysis was conducted with a random-effects model. A total of 18 randomized trials including 20,536 diabetes patients were included. Results The network analysis showed that short-term DAPT was the best for reducing the primary endpoint and was superior to extended-term DAPT (odds ratio [OR] 0.48, 95% CI: 0.25-0.85). Standard-term DAPT was also associated with a reduced primary endpoint in comparison with extended-term DAPT (OR 0.56, 95% CI: 0.32-0.90). There was no noticeable difference with respect to the primary endpoint between short-term DAPT followed by aspirin monotherapy and P2Y12 inhibitor monotherapy. No significant differences were observed in secondary endpoints, including all-cause mortality, cardiac mortality, myocardial infarction, stroke, target vessel revascularization, definite or probable stent thrombosis, and major bleeding event. Conclusions Short-term DAPT was associated with better primary endpoint benefit for patients with diabetes after PCI with DES than extended-term DAPT.