Benefits and harms of extended dual antiplatelet therapy (DAPT; > 12 mo) compared with standard DAPT (6–12 mo) among participants aged younger than 75 years or 75 years and older*
| Outcome† | ≥ 75 yr | < 75 yr | ||||||
|---|---|---|---|---|---|---|---|---|
| RCTs | No. events (no. participants) | RR (95% CI)‡; I2 | RCTs | No. events (no. participants) | RR (95% CI)‡; I2 | |||
| > 12 mo | 6–12 mo | > 12 mo | 6–12 mo | |||||
| All-cause death | ITALIC;7 PRODIGY10 | 33 (420) | 35 (428) | 1.32 (0.39–4.54); 61% | PRODIGY | 17 (704) | 10 (679) | 1.64 (0.76–3.56); NA |
| Cardiovascular death | ITALIC;7 PRODIGY10 | 15 (420) | 20 (428) | 0.98 (0.24–4.04); 29% | PRODIGY | 5 (704) | 2 (679) | 2.41 (0.47–12.39); NA |
| Myocardial infarction | ITALIC;7 PRODIGY;10 DAPT11 | ITALIC, PRODIGY: 20 (420); DAPT: NR | ITALIC, PRODIGY: 14 (428); DAPT: NR | ITALIC, PRODIGY: 1.48 (0.63–3.47); 6% DAPT: HR 0.76 (0.38–1.54); NA | PRODIGY, DAPT | PRODIGY: 10 (704); DAPT: NR | PRODIGY: 9 (679); DAPT: NR | PRODIGY: 1.07 (0.44–2.62); NA DAPT; HR 0.46 (0.36–0.60); NA |
| Stroke | PRODIGY10 | 8 (283) | 1 (304) | 8.59 (1.08–68.28); NA | PRODIGY | 9 (704) | 3 (679) | 2.89 (0.79–10.64); NA |
| Definite ST | PRODIGY10 | 1 (283) | 2 (304) | 0.54 (0.05–5.89); NA | PRODIGY | 4 (704) | 4 (679) | 0.96 (0.24–3.84); NA |
| Probable or definite ST | PRODIGY;10 DAPT11 | PRODIGY: 4 (283); DAPT: NR | PRODIGY: 6 (304); DAPT: NR | PRODIGY 0.72 (0.20–2.51); NA DAPT: HR 0.23 (0.03–2.06); NA | PRODIGY, DAPT | PRODIGY: 4 (704); DAPT: NR | PRODIGY: 4 (679); DAPT: NR | PRODIGY: 0.96 (0.24–3.84); NA DAPT: HR 0.29 (0.17–0.49); NA |
| Urgent revascularization | ITALIC7 | 1 (137) | 1 (124) | 0.91 (0.06–14.32); NA | – | – | – | – |
| MACCE§ | PRODIGY;10 DAPT11 | PRODIGY: 28 (283); DAPT: NR | PRODIGY: 31 (304); DAPT: NR | PRODIGY: 0.97 (0.60–1.58); NA DAPT: HR 0.95 (0.59–1.52); NA | PRODIGY, DAPT | PRODIGY: 33 (704); DAPT: NR | PRODIGY: 20 (679); DAPT: NR | PRODIGY: 1.59 (0.92–2.75); NA DAPT: HR 0.69 (0.57–0.83); NA |
| TIMI minor bleeding | ITALIC7 | 1 (137) | 3 (124) | 0.30 (0.03–2.86); NA | – | – | – | – |
| GUSTO moderate or severe bleeding | PRODIGY;10 DAPT11 | PRODIGY: 14 (283); DAPT: NR | PRODIGY: 3 (304); DAPT: NR | PRODIGY: 5.01 (1.46–17.26); NA DAPT: HR 1.03 (0.54–1.98); NA | PRODIGY, DAPT | PRODIGY: 8 (704); DAPT: NR | PRODIGY: 5 (679); DAPT: NR | PRODIGY: 1.54 (0.51–4.69); NA DAPT: HR 1.78 (1.29–2.47); NA |
| BARC type 3 bleeding | PRODIGY10 | 9 (283) | 4 (304) | 2.42 (0.75–7.76); NA | PRODIGY | 9 (704) | 5 (679) | 1.74 (0.58–5.15); NA |
| BARC type 2, 3, 5 bleeding | PRODIGY10 | 23 (283) | 9 (304) | 2.75 (1.29–5.83); NA | PRODIGY | 30 (704) | 11 (679) | 2.63 (1.33–5.21); NA |
Note: BARC = Bleeding Academic Research Consortium, CI = confidence interval, HR = hazard ratio, GUSTO = Global Use of Strategies to Open Occluded Coronary Arteries, MACCE = major adverse cardiovascular and cerebrovascular event, NA = not applicable, NR = not reported, RCT = randomized controlled trial, RR = relative risk, ST = stent thrombosis, TIMI = Thrombolysis In Myocardial Infarction.
↵* Corresponding forest plots are presented in Appendix 1 and Figure 2. See Table 2 for bleeding outcome definitions.
↵† No outcome data available: noncardiovascular death, gastrointestinal bleeding, TIMI major bleeding, GUSTO moderate bleeding, GUSTO severe bleeding, BARC type 5 bleeding.
↵‡ Unless otherwise stated.
↵§ Composite outcome: all-cause death, myocardial infarction or stroke.