De-escalation of Antiplatelet Therapy Retains P2Y12 Inhibitor After Percutaneous Coronary Intervention Among East Asians and Non-East Asians: A Meta-Analysis of Randomized Controlled Trials

Background: The impact of de-escalation of antiplatelet therapy retains P2Y12 inhibitor on major bleeding and ischemic outcomes after percutaneous coronary intervention (PCI) among East Asians and non-East Asians was unclear. Methods: : We systematically searched PubMed, Embase and the Cochrane Library for randomized controlled trials through September 2020. Eight trials were included, which studied de-escalation of DAPT (D-DAPT, switching to P2Y12 inhibitor monotherapy or decreasing the intensity of P2Y12 inhibitor after 1 to 3 months) versus 12 months standard DAPT (S-DAPT). The primary outcomes data were conducted with random effects models. Results: : Among 8 included trials with 37,775 patients, 62.6% of patients presented with acute coronary syndrome. The median follow-up duration ranged from 12 to 24 months. Compared with S-DAPT, D-DAPT was associated with a lower risk of major bleeding (RR=0.64, 95%CI: 0.47-0.88, p =0.006), but this was only observed among East-Asians (RR=0.55, 95%CI: 0.38-0.81, p =0.002). Among non-East Asians, the rate of major bleeding was similar between two groups (RR=0.73, 95% CI: 0.46-1.14, p =0.17). There was no significant difference of MACE between D-DAPT and S-DAPT treatment among both East Asians (RR=0.84, 95%CI: 0.66-1.08, p =0.18) and non-East Asians (RR=0.89, 95%CI: 0.79-1.00, p =0.05). Conclusions: : De-escalation strategy retains P2Y12 inhibitor after PCI was associated with reduced risk of bleeding events, which was only demonstrated in East Asians patients, but not in non-East Asians patients.