Palmerini T, ….Stone GW. Lancet 2015:on-line

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Presentation transcript:

Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts All-cause Death HR (95% CI) Weight (%) Events Group 1 Events Group 2 Study 22% ↑ mortality with prolonged DAPT (p=0.02) ARTIC Interruption DAPT DES LATE EXCELLENT ISAR SAFE ITALIC OPTIMIZE PRODIGY RESET SECURITY 1.32 (0.49, 3.55) 0.75 (0.56, 1.02) 0.71 (0.45, 1.10) 0.57 (0.17, 1.95) 0.66 (0.27, 1.63) 1.14 (0.41, 3.15) 0.95 (0.63, 1.45) 0.91 (0.61, 1.37) 0.62 (0.20, 1.88) 1.00 (0.37, 2.66) 0.82 (0.69, 0.98) 3.03 33.00 14.85 1.99 3.67 2.85 17.07 18.12 2.36 3.05 100.00 9/624 74/4941 32/2514 4/722 8/1997 8/912 43/1563 45/751 5/1059 8/682 236/ 15765 7/635 98/5020 46/251 7/721 12/2003 7/910 45/1556 49/750 8/1058 8/717 287/1590 I-V (I2=0.0%, p=0.93); p value for ES=0.02 D+L: p value for ES=0.02 .1 .5 1 2 3 5 Shorter DAPT better Longer DAPT better ES=effect size Palmerini T, ….Stone GW. Lancet 2015:on-line

Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts Cardiac Death HR (95% CI) Weight (%) Events Group 1 Events Group 2 Study 8% ↑ cardiac mortality with prolonged DAPT (p=NS) DAPT DES LATE EXCELLENT ITALIC OPTIMIZE PRODIGY RESET SECURITY 1.04 (0.70, 1.53) 0.68 (0.38, 1.23) 0.67 (0.11, 3.99) 1.67 (0.40, 6.97) 0.90 (0.55, 1.49) 0.92 (0.53, 1.58) 0.50 (0.91, 2.73) 1.64 (0.41, 6.59) 0.93 (0.73, 1.17) 35.40 15.69 1.68 2.65 21.79 18.14 1.86 2.81 100.00 52/4941 19/2514 2/722 5/912 29/1563 25/751 2/1059 5/682 139/ 13144 50/5020 28/2531 3/721 3/910 32/1556 27/750 4/1058 3/717 150/13263 I-V (I2=0.0%, p=0.85); p value for ES=0.52 D+L: p value for ES=0.52 .1 .5 1 2 3 5 Shorter DAPT better Longer DAPT better ES=effect size Palmerini T, ….Stone GW. Lancet 2015:on-line

Non- cardiac mortality Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts Non-cardiac Death HR (95% CI) Weight (%) Events Group 1 Events Group 2 49% ↑ Non- cardiac mortality with prolonged DAPT (p=0.006) Study DAPT DES LATE EXCELLENT ITALIC OPTIMIZE PRODIGY RESET SECURITY 0.47 (0.29, 0.76) 0.68 (0.34, 1.37) 0.50 (0.09, 2.74) 0.75 (0.17, 3.30) 1.07 (0.50, 2.28) 0.90 (0.49, 1.65) 0.73 (0.16, 3.26) 0.60 (0.15, 2.42) 0.67 (0.51, 0.89) 34.27 16.38 2.73 3.62 13.82 21.58 3.50 4.11 100.00 22/4941 13/2514 2/722 3/912 14/1563 20/751 3/1059 3/682 80/ 13144 48/5020 19/2531 4/721 4/910 13/1556 22/750 4/1058 5/717 119/13263 I-V (I2=0.0%, p=0.71); p value for ES=0.006 D+L: p value for ES=0.006 .1 .5 1 2 3 5 Shorter DAPT better Longer DAPT better ES=effect size Palmerini T, ….Stone GW. Lancet 2015:on-line

Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts Major Bleeding HR (95% CI) Weight (%) Events Group 1 Events Group 2 Study 72% ↑ bleeding with prolonged DAPT (p<0.0001) ARTIC Interruption DAPT DES LATE EXCELLENT ISAR SAFE ITALIC OPTIMIZE PRODIGY RESET SECURITY 0.15 (0.02, 1.20) 0.57 (0.43, 0.75) 0.71 (0.42, 1.20) 0.50 (0.09, 2.73) 0.80 (0.21, 2.98) 0.13 (0.01, 1.30) 0.71 (0.32, 1.60) 0.38 (0.14, 1.07) 0.75 (0.17, 3.35) 0.51 (0.16, 1.59) 0.58 (0.47, 0.72) 1.10 59.86 16.81 1.59 2.63 0.78 7.16 4.48 2.08 3.51 100.00 1/624 72/4941 24/2514 2/722 4/1997 0/912 10/1563 5/751 2/1059 4/682 124/ 15765 7/635 129/5020 34/2531 4/721 5/2003 3/910 12/1556 6/750 6/1058 8/717 221/15901 I-V (I2=0.0%, p=0.83); p value for ES<0.0001 D+L: p value for ES<0.0001 .1 .5 1 2 3 5 Shorter DAPT better Longer DAPT better ES=effect size Palmerini T, ….Stone GW. Lancet 2015:on-line

Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts MI HR (95% CI) Weight (%) Events Group 1 Events Group 2 Study 25% ↓ MI with prolonged DAPT (p=0.01) ARTIC Interruption DAPT DES LATE EXCELLENT ISAR SAFE ITALIC OPTIMIZE PRODIGY RESET SECURITY 1.04 (0.41, 2.62) 1.94 (1.55, 2.44) 1.43 (0.80, 2.58) 1.86 (0.74, 4.67) 0.93 (0.44, 1.97) 1.50 (0.42, 5.32) 1.17 (0.77, 1.76) 1.04 (0.60, 1.79) 0.50 (0.91, 2.72) 1.06 (0.53, 2.16) 1.51 (1.28, 1.77) 1.34 (1.07, 1.69) 3.01 50.33 7.56 3.05 4.61 1.61 15.16 8.67 0.75 5.25 100.00 9/624 198/4941 27/2514 13/722 13/1997 6/912 49/1563 26/751 2/1059 16/682 359/ 15765 9/635 99/5020 19/2531 7/721 14/2003 4/910 42/1556 25/750 1/1058 15/717 238/15901 I-V (I2=29.3%, p=0.17); p value for ES<0.0001 D+L: p value for ES=0.01 .1 .5 1 2 3 5 Shorter DAPT better Longer DAPT better ES=effect size Palmerini T, ….Stone GW. Lancet 2015:on-line

Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts Definite/ Probable ST HR (95% CI) Weight (%) Events Group 1 Events Group 2 Study 41% ↓ stent thrombosis with prolonged DAPT (p=0.06) DAPT EXCELLENT ISAR SAFE ITALIC OPTIMIZE PRODIGY RESET SECURITY 2.98 (1.95, 4.58) 6.02 (0.72, 49.96) 1.25 (0.33, 4.65) 7.38 (0.76, 71.00) 1.08 (0.49, 2.36) 1.24 (0.49, 3.14) 0.66 (0.11, 3.98) 0.67 (0.11, 3.86) 2.04 (1.48, 2.80) 55.53 2.25 5.79 1.97 16.38 11.73 3.14 3.20 100.00 65/4941 6/722 5/1997 3/912 13/1563 10/751 2/1059 2/682 106/ 13251 19/5020 1/721 4/2003 0/910 12/1556 8/750 3/1058 3/717 53/ 13370 I-V (I2=43.7%, p=0.09); p value for ES<0.0001 D+L: p value for ES=0.06 1.68 (0.98, 2.87) .1 .5 1 2 3 5 Shorter DAPT better Longer DAPT better ES=effect size Palmerini T, ….Stone GW. Lancet 2015:on-line

Palmerini T, ….Stone GW. Lancet 2015:on-line Mortality with Extended Duration DAPT After DES: A Pairwise and Bayesian Network Meta-Analysis of 10 RCTs and 31,666 Pts Yellow: sig ↓ w/short DAPT Orange: sig ↑ w/short DAPT ≤6-month vs 1-year DAPT HR (95% CrI) 6-month vs >1-year DAPT 1-year vs >1-year DAPT All-cause death 0.95 (0.76-1.20) 0.78 (0.59-1.00) 0.82 (0.65-1.00) - Cardiac 0.96 (0.68-1.40) 0.90 (0.62-1.30) 0.93 (0.69-1.20) - Non-cardiac 1.00 (0.69-1.60) 0.65 (0.41-1.00) 0.61 (0.42-0.87) Myocardial infarction 1.00 (0.75-1.30) 1.70 (1.30-2.40) 1.70 (1.40-2.10) Def/prob stent thrombosis 1.10 (0.66-1.70) 2.70 (1.50-5.00) 2.50 (1.70-4.00) Major bleeding 0.59 (0.36-0.95) 0.34 (0.20-0.55) 0.58 (0.45-0.74) Palmerini T, ….Stone GW. Lancet 2015:on-line