Abstract 4148051: Comparative Efficacy of Dual Antiplatelet Therapy Durations in Acute Coronary Syndrome Patients Undergoing PCI: A Network Meta-Analysis

Background: Dual antiplatelet therapy, involving aspirin and a P2Y12 inhibitor, is essential for preventing ischemic events in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Only limited number of studies challenge the optimal duration of DAPT in patients with ACS undergoing PCI. Methods: Pubmed and EMBASE databases were queried up to June 2024, and 7 eligible randomized clinical trials were included in our final analysis. We compared the efficacy and safety of different durations of DAPT in patients with ACS who underwent PCI. Outcomes studied included all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE), stent thrombosis, and clinically significant bleeding. We used a network meta-analysis module with inverse variance and random effects model in CRAN-R software to compute pooled risk ratios (RR) with 95% confidence intervals (CI) for statistical significance, using the 12-month DAPT strategy as a reference. Higgin’s I2 was used to test heterogeneity. Results: When compared to 12 months of DAPT therapy, there was no difference in all causes of mortality, CV death, MI, stroke, MACE, and stent thrombosis with a shorter duration of DAPT (1 month and 3 months). However, there was a lower risk of bleeding with 1 month and 3 months of DAPT therapy (Table 1). Conclusion: Shorter durations of DAPT (1 month and 3 months) are as effective as the traditional 12-month regimen in preventing all-cause mortality, CV death, MI, stroke, MACE, and stent thrombosis in patients with ACS undergoing PCI. Importantly, shorter DAPT durations are associated with a significantly lower risk of bleeding.