急性冠脉综合征患者接受PCI治疗的超短程与标准疗程双联抗血小板治疗：一项荟萃分析。
完整摘要 · 中文译文
背景：超短程（≤1个月）双联抗血小板治疗（DAPT）后转为抗血小板单药治疗在急性冠脉综合征（ACS）患者中的有效性和安全性仍不明确。 目的：本研究旨在比较接受经皮冠状动脉介入治疗（PCI）的ACS患者中，超短程与标准疗程DAPT的差异。 方法：我们进行了一项截至2026年2月15日的随机对照试验的系统评价和荟萃分析。主要结局为主要不良心脑血管事件（MACCE）、大出血和净不良临床事件（NACE）。预设亚组分析按种族（东亚 vs 非东亚）和降阶策略（强化：≤1周DAPT或氯吡格雷/阿司匹林单药治疗 vs 中度：≥2周DAPT，之后替格瑞洛/普拉格雷单药治疗）进行。 结果：在10项试验（n = 29,232）中，超短程双联抗血小板治疗（DAPT）未增加主要不良心脑血管事件（MACCE）风险（HR：1.06；95% CI：0.93-1.20；P = 0.38；I2 = 24%），在ST段抬高型心肌梗死（STEMI）中观察到MACCE风险升高，但在非ST段抬高型急性冠脉综合征（NSTE-ACS）中未观察到；同时显著减少大出血（HR：0.47；95% CI：0.35-0.64；P < 0.00001；I2 = 44%），从而带来净临床获益（HR：0.83；95% CI：0.72-0.97；P = 0.02；I2 = 61%）。出血减少在东亚人群中更显著（HR：0.35；95% CI：0.25-0.49；P < 0.00001；I2 = 0%），而非东亚人群为（HR：0.63；95% CI：0.43-0.93；P = 0.02；I2 = 44%），存在显著交互作用（P = 0.02）。缩短疗程策略显著改变结局（交互作用P = 0.003）：强化缩短升高MACCE风险（HR：1.37；95% CI：1.11-1.69；P = 0.003；I2 = 0%），而适度缩短无统计学显著差异（HR：0.96；95% CI：0.85-1.08；P = 0.47；I2 = 0%）。 结论：在接受经皮冠状动脉介入治疗（PCI）的ACS患者中，超短程DAPT在不增加总体缺血事件的情况下减少出血，尽管在STEMI中观察到MACCE增加信号，但在NSTE-ACS中未观察到。出血减少在东亚人群中更显著，而≤1周DAPT或氯吡格雷/阿司匹林单药治疗可能增加缺血风险。
完整摘要 · 英文原文
BACKGROUND: The efficacy and safety of ultrashort (≤1-month) dual antiplatelet therapy (DAPT) followed by antiplatelet monotherapy remain uncertain in acute coronary syndrome (ACS) patients. OBJECTIVES: This study sought to compare ultrashort vs standard-duration DAPT in patients with ACS undergoing percutaneous coronary intervention (PCI). METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials until February 15, 2026. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), major bleeding, and net adverse clinical event (NACE). Prespecified subgroup analyses examined by ethnicity (East Asian vs non-East Asian) and abbreviation strategy (intensive: ≤1-week DAPT or clopidogrel/aspirin monotherapy vs moderate: ≥2-week DAPT, followed by ticagrelor/prasugrel monotherapy). RESULTS: Across 10 trials (n = 29,232), ultrashort DAPT did not increase MACCE risk (HR: 1.06; 95% CI: 0.93-1.20; P = 0.38; I2 = 24%), with higher MACCE risk observed in ST-segment elevation myocardial infarction (STEMI) but not non-ST-segment elevation ACS (NSTE-ACS), and significantly reduced major bleeding (HR: 0.47; 95% CI: 0.35-0.64; P < 0.00001; I2 = 44%), resulting in a net clinical benefit (HR: 0.83; 95% CI: 0.72-0.97; P = 0.02; I2 = 61%). Bleeding reduction was more pronounced in East Asians (HR: 0.35; 95% CI: 0.25-0.49; P < 0.00001; I2 = 0%) than non-East Asians (HR: 0.63; 95% CI: 0.43-0.93; P = 0.02; I2 = 44%), with a significant interaction (P = 0.02). The abbreviation strategy significantly modified outcomes (P for interaction = 0.003): intensive abbreviation raised MACCE risk (HR: 1.37; 95% CI: 1.11-1.69; P = 0.003; I2 = 0%), while moderate abbreviation had no statistically significant difference (HR: 0.96; 95% CI: 0.85-1.08; P = 0.47; I2 = 0%). CONCLUSIONS: In patients with ACS undergoing PCI, ultrashort DAPT reduced bleeding without increasing ischemic events overall, although a signal of increased MACCE was observed in STEMI but not in NSTE-ACS. Bleeding reduction was greater in East Asians, while ≤1-week DAPT or clopidogrel/aspirin monotherapy may increase ischemic risk.