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Eur Heart J Qual Care Clin Outcomes. 2017 Oct 1;3(4):303-311. doi: 10.1093/ehjqcco/qcw051.

Duration of dual antiplatelet therapy and associated outcomes following percutaneous coronary intervention for acute myocardial infarction: contemporary practice insights from the Canadian Observational Antiplatelet Study.

Author information

1
Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly 6-030, Toronto, ON M5B 1W8, Canada.
2
University of Ottawa Heart Institute, Ottawa, ON, Canada.
3
Canadian Heart Research Centre, Toronto, ON, Canada.
4
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
5
Eli Lilly Canada, Toronto, ON, Canada.
6
Eli Lilly and Company, Indianapolis, IN.
7
The Mazankowski Alberta Heart Institute, University of Alberta, VIGOUR Centre, Edmonton, AB, Canada.
8
Royal Jubilee Hospital, Victoria Heart Institute, Victoria, BC, Canada.
9
Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
10
Health Sciences North, Sudbury, ON, Canada.
11
Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.
12
New Brunswick Heart Centre, CardioVascular Research New Brunswick, Saint John, NB, Canada.
13
London Health Sciences Centre, Western University, London, ON, Canada.
14
Hamilton Health Sciences, McMaster University, Population Health Research Institute, Hamilton, ON, Canada.

Abstract

Aims:

There is a paucity of real-world, contemporary data of practice patterns and clinical outcomes following dual-antiplatelet therapy (DAPT) in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).

Methods and results:

The Canadian Observational Antiplatelet Study was a prospective, multicentre, cohort study examining adenosine diphosphate receptor antagonist use following PCI for AMI. We compared practice patterns, patient characteristics, and clinical outcomes in relation to DAPT duration (<6 weeks, 6 weeks to <6 months, 6 to <12, and ≥12 months). The primary outcome was the composite of non-fatal AMI, unplanned coronary revascularization, stent thrombosis, new or worsening heart failure, cardiogenic shock, or stroke. We identified 2034 patients with AMI treated with PCI. DAPT duration was <6 weeks in 5.2% of patients; 6 weeks to <6 months in 7.0%; 6 to <12 months in 12.6%; and ≥12 months in 75.3%. Patients who discontinued DAPT early had higher GRACE risk scores. Overall, mortality rate at 15 months was 2.5%. Compared with a duration of DAPT of ≥12 months, discontinuation of DAPT <6 weeks (P < 0.0001) and 6 weeks to <6 months (P = 0.02), but not 6 months to <12 months (P = 0.06), were independently associated with a higher incidence of the primary outcome among survivors.

Conclusion:

One-in-four patients with AMI treated with PCI discontinued DAPT prior to the guideline-recommended 12-month duration. Patients in whom DAPT was discontinued early were at higher baseline risk and had higher rates of non-fatal ischaemic events during follow up.

KEYWORDS:

Angioplasty ; Cardiovascular outcomes; Dual antiplatelet therapy ; Myocardial infarction

PMID:
29044393
DOI:
10.1093/ehjqcco/qcw051
[Indexed for MEDLINE]

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