Duration of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation in Diabetic and Non-Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Sharma, Abhishek; Garg, Aakash; Elmariah, Sammy; Drachman, Douglas E.; Obiagwu, Chukwudi; Vallakati, Ajay; Sharma, Samin K.; Lavie, Carl J.; Mukherjee, Debabrata; Waksman, Ron; Feres, Fausto; Marmur, Jonathan D.; Helft, Gérard

doi:10.1016/j.pcad.2017.12.003

Cited by 17 publications

(13 citation statements)

References 44 publications

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“…This might be because our analysis evaluated different trials and subgroups. Another meta-analysis published by Sharma et al [24] found that the risks for MI, TVR, and ST were similar in patients with DM after PCI treated by short-or long-term DAPT. From these results, it is not difficult to see that long-term DAPT is not superior to short-term DAPT in preventing ischemic events in patients with DM after PCI.…”

Section: Plos One Plos Onementioning

confidence: 96%

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials

Zhang

Huang

et al. 2020

PLoS ONE

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Background Diabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant. Objective The purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation. Methods We searched PubMed, Embase, and the Cochrane Library for studies that compared short-term (≤ 6 months) and long-term (≥ 12 months) DAPT in patients with DM. The primary endpoints were late (31–365 days) and very late (> 365 days) stent thrombosis (ST). The secondary endpoints included myocardial infarction (MI), target vessel recanalization (TVR), all-cause death, and major bleeding. Results Six randomized controlled trials, with a total of 3,657 patients with DM, were included in the study. In terms of the primary endpoint, there was no significant difference between the two groups in late (OR 1.15, 95% CI: 0.42–3.19, P = 0.79) or very late (OR 2.18, 95% CI: 0.20–24.18; P = 0.53) ST. Moreover, there was no significant difference in the secondary endpoints, including MI (OR 1.11, 95% CI: 0.72–1.71, P = 0.63), TVR (OR 1.31, 95% CI: 0.82–2.07, P = 0.26), all-cause death (OR 1.03, 95% CI: 0.61–1.75, P = 0.90) and major bleeding (OR 1.07, 95% CI: 0.34–3.40, P = 0.90) between the two groups. Conclusion Our study demonstrated that compared with long-term DAPT, short-term DAPT had no significant difference in the clinical outcomes of patients with DM implanted with second-generation DES.

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Section: Plos One Plos Onementioning

confidence: 96%

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials

Zhang

Huang

et al. 2020

PLoS ONE

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“…The patients with DM were low in these trials and therefore these results should not be applied to diabetic patients. In addition, although some clinical trials revealed that the clinical outcomes with short DAPT were non-inferior to those with long DAPT in DM patients, the duration of short DAPT was around 6 months [49,50]. In the present study, the CAS evaluations demonstrated that the rate of the minimum NIC of grade 0 was significantly higher in the DM group than in the non-DM group 3-5 months after DES implantation, which is consistent with the concept that DM is a factor that increases the thrombotic risk even in the early phase.…”

Section: Discussionmentioning

confidence: 99%

Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation

Ishihara

Sotomi

Tsujimura

et al. 2020

Cardiovasc Diabetol

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Background Early arterial healing after drug-eluting stent (DES) implantation may enable short dual-antiplatelet therapy (DAPT) strategy. The impact of diabetes mellitus (DM) on this healing has not been elucidated. We used coronary angioscopy (CAS) to compare intravascular status of DM and non-DM patients in the early phase after DES implantation. Methods This study was a multicenter retrospective observational study. We analyzed CAS findings of 337 lesions from 270 patients evaluated 3–5 months after DES implantation. We divided the lesion into two groups: DM (n = 149) and non-DM (n = 188). We assessed neointimal coverage (NIC) grades (dominant, maximum and minimum), thrombus adhesion and maximum yellow color grade. NIC was graded as follows: grade 0, stent struts were not covered; grade 1, stent struts were covered by thin layer; grade 2, stent struts were buried under neointima. Yellow color was graded as grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow. Results Minimum NIC grade was significantly lower in DM than in non-DM groups (p = 0.002), whereas dominant and maximum NIC grades were similar between them (p = 0.59 and p = 0.94, respectively), as were thrombus adhesion (44.3% vs. 38.8%, p = 0.32) and maximum yellow color grade (p = 0.78). A multivariate analysis demonstrated that DM was an independent predictor of minimum NIC of grade 0 (odds ratio: 2.14, 95% confidence interval: 1.19–3.86, p = 0.011). Conclusions DM patients showed more uncovered struts than non-DM patients 3–5 months after DES implantation, suggesting that the recent ultra-short DAPT strategy might not be easily applied to DM patients.

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“…The described biofunctionalized stent might find particular application in clinical settings in which double antiplatelet therapy, particularly in the long term, is considered too risky for the patient as interruptions of antiplatelet therapy can lead to life-threatening stent thrombosis. 54 A more extensive preclinical study is planned to verify these promising initial observations. CONCLUSION 316L steel stents were functionalized by attachment of anti-VEGFR2 human scFv antibody fragments.…”

Section: Discussionmentioning

confidence: 99%

“…Early coverage of stent surfaces with ECs would also reduce susceptibility to acute and subacute stent thrombosis compared to drug eluting stents. The described biofunctionalized stent might find particular application in clinical settings in which double antiplatelet therapy, particularly in the long term, is considered too risky for the patient as interruptions of antiplatelet therapy can lead to life‐threatening stent thrombosis . A more extensive preclinical study is planned to verify these promising initial observations.…”

Section: Discussionmentioning

confidence: 99%

Functionalization with a VEGFR2‐binding antibody fragment leads to enhanced endothelialization of a cardiovascular stent in vitro and in vivo

et al. 2019

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Rapid endothelialization of cardiovascular stents is critical to prevent major clinical complications such as restenosis. Reconstruction of the native endothelium on the stent surface can be achieved by the capture of endothelial progenitor cells (EPCs) or neighboring endothelial cells (ECs) in vivo. In this study, stainless steel cardiovascular stents were functionalized with recombinant scFv antibody fragments specific for vascular endothelial growth factor receptor‐2 (VEGFR2) that is expressed on EPCs and ECs. Anti‐VEGFR2 scFvs were expressed in glycosylated form in Escherichia coli and covalently attached to amine‐functionalized, titania‐coated steel disks and stents. ScFv‐coated surfaces exhibited no detectable cytotoxicity to human ECs or erythrocytes in vitro and bound 15 times more VEGFR2‐positive human umbilical vein ECs than controls after as little as 3 min. Porcine coronary arteries were successfully stented with scFv‐coated stents with no adverse clinical events after 30 days. Endovascular imaging and histology revealed coverage of the anti‐VEGFR2 scFv‐coated stent with a cell layer after 5 days and the presence of a neointima layer with a minimum thickness of 80 μm after 30 days. Biofunctionalization of cardiovascular stents with endothelial cell‐capturing antibody fragments in this manner offers promise in accelerating stent endothelialization in vivo. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:213–224, 2020.

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Duration of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation in Diabetic and Non-Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract: Compared to L-DAPT, S-DAPT was associated with significant increase in rate of ST in non-DM patients. Duration of DAPT had no significant impact on rates of all-cause mortality, cardiac mortality, MI, ST and TVR among DM patients.

Cited by 17 publications

References 44 publications

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials

Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials

Impact of diabetes mellitus on the early-phase arterial healing after drug-eluting stent implantation

Functionalization with a VEGFR2‐binding antibody fragment leads to enhanced endothelialization of a cardiovascular stent in vitro and in vivo

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