CBS - The 17th Left Main & Coronary Bifurcation Summit, CBS2025

HOME | SCIENTIFIC LIBRARY | 双重抗血小板治疗持续时间

双重抗血小板治疗持续时间

Aspirin-Free Prasugrel Monotherapy Following Coronary Artery Stenting in Patients With Stable CAD: The ASET Pilot Study State of the art: duration of dual antiplatelet therapy after percutaneous coronary intervention and coronary stent implantation - past, present and future perspectives. Prasugrel versus clopidogrel in patients with acute coronary syndromes Clopidogrel or ticagrelor in acute coronary syndrome patients treated with newer-generation drug-eluting stents: CHANGE DAPT Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months versus aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicenter, open-label, randomized superiority trial Ticagrelor with or without Aspirin in High-Risk Patients after PCI The optimal duration of dual antiplatelet therapy after coronary stent implantation: to go too far is as bad as to fall short Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry)

Sort by hits |<< 1 2 3 4 5 6 7 ...>>|

Original Research2015 Nov 4;351:h5392.

JOURNAL：BMJ. Article Link

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Giacoppo D, Gargiulo G, Capodanno D et al. Keywords: Plain Old Balloon Angioplasty; Vascular Brachytherapy; Cutting and Scoring Balloons; Rotational Atherectomy; Laser Techniques; Repeat Stenting with Bare Metal Stents; Repeat Stenting with Drug-Eluting Stents; Drug-Coated Balloons

ABSTRACT

STUDY QUESTION - What is the most safe and effective interventional treatment for coronary in-stent restenosis?

METHODS - In a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, and major scientific websites were screened up to 10 August 2015. Randomised controlled trials of patients with any type of coronary in-stent restenosis (either of bare metal stents or drug eluting stents; and either first or recurrent instances) were included. Trials including multiple treatments at the same time in the same group or comparing variants of the same intervention were excluded. Primary endpoints were target lesion revascularisation and late lumen loss, both at six to 12 months. The main analysis was complemented by network subanalyses, standard pairwise comparisons, and subgroup and sensitivity analyses.

STUDY ANSWER AND LIMITATIONS - Twenty four trials (4880 patients), including seven interventional treatments, were identified. Compared with plain balloons, bare metal stents, brachytherapy, rotational atherectomy, and cutting balloons, drug coated balloons and drug eluting stents were associated with a reduced risk of target lesion revascularisation and major adverse cardiac events, and with reduced late lumen loss. Treatment ranking indicated that drug eluting stents had the highest probability (61.4%) of being the most effective for target lesion vascularisation; drug coated balloons were similarly indicated as the most effective treatment for late lumen loss (probability 70.3%). The comparative efficacy of drug coated balloons and drug eluting stents was similar for target lesion revascularisation (summary odds ratio 1.10, 95% credible interval 0.59 to 2.01) and late lumen loss reduction (mean difference in minimum lumen diameter 0.04 mm, 95% credible interval -0.20 to 0.10). Risks of death, myocardial infarction, and stent thrombosis were comparable across all treatments, but these analyses were limited by a low number of events. Trials had heterogeneity regarding investigation periods, baseline characteristics, and endpoint reporting, with a lack of information at long term follow-up. Direct and indirect evidence was also inconsistent for the comparison between drug eluting stents and drug coated balloons.

WHAT THIS STUDY ADDS - Compared with other currently available interventional treatments for coronary in-stent restenosis, drug coated balloons and drug eluting stents are associated with superior clinical and angiographic outcomes, with a similar comparative efficacy.

FUNDING, COMPETING INTERESTS, DATA SHARING - This study received no external funding. The authors declare no competing interests. No additional data available.

Abstract

Recommended Article

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

ABSTRACT