Efficacy and Safety Outcomes of Short Duration Antiplatelet Therapy with Early Cessation of Aspirin Post Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.

BACKGROUND: The optimal duration of dual antiplatelet therapy is a matter of ongoing research. Clinical studies are assessing the optimal duration with the most favourable risk to benefit ratio. The efficacy of P2Y12 receptor inhibitors comparable to aspirin in preventing recurrent ischaemic events in patients with coronary artery diseases. OBJECTIVES: To investigate the outcomes of short-duration dual antiplatelet therapy after PCI with early discontinuation of aspirin while maintaining patients on P2Y12 inhibitor through systematic review and meta-analysis of available literature. METHODS: We systematically searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. We included randomized controlled studies that measured clinical outcomes of efficacy (mortality and ischaemic events) and safety (bleeding) of short and standard-duration dual antiplatelet therapy. The protocol of this study was registered in the international prospective register of systematic reviews PROSPERO registry (CRD42020171468). RESULTS: Four randomized controlled trials were included; GLOBAL LEADERS, SMARTCHOICE, STOPDAPT-2, and TWILIGHT. The total number of patients was 29,089. The safety outcomes showed a significant reduction in major bleeding events with short-duration dual antiplatelet therapy; the risk ratio was 0.61 (95% CI 0.38-0.99; z=2,00, p=0.05). There was no difference between short and standard-duration dual antiplatelet therapy regarding efficacy outcomes (all- cause death, major adverse cardiovascular events, myocardial infarction, stroke, and stent thrombosis). CONCLUSION: Short-duration dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy after PCI is a feasible option and can be adopted, especially in patients with a high risk of bleeding.

Arrhythmogenic right ventricular cardiomyopathy/dysplasia in Iraq.

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a disorder that involves replacement of the right ventricular myocardium with fibro-fatty tissue. Ventricular tachycardia is a main presenting feature. There are no known reports of this disease from the Arab countries in the Middle East. This is the first report of 34 patients from Iraq. METHODS: Thirty four patients with ARVC/D diagnosed from January 2003 to May 2007 according to the International Task Force criteria were included in this study. RESULTS: All patients presented with ventricular tachycardia of left bundle branch block morphology. The following findings were seen on the 12-lead electrocardiography during sinus rhythm: T wave inversion V1-V3 or beyond in 80%, epsilon wave in 28%, and parietal block in 48%. Right ventricular enlargement by echocardiography was seen in 69%. Twenty two per cent had a family history of sudden cardiac death. All patients were treated with implanted cardioverter-defibrillators. CONCLUSIONS: ARVC/D is a disease seen in Iraq. It requires a high diagnostic suspicion with verification using the international task force criteria.