Evaluation of the Use of Dual Antiplatelet Therapy beyond the First Year after Acute Coronary Syndrome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Study Variables and Follow-Up
2.3. Objectives
2.4. Statistical Analysis
3. Results
3.1. DAPT Duration
3.2. Criteria for Candidates for Extended DAPT
3.2.1. Univariate Analysis
3.2.2. Multivariate Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographics | ||
---|---|---|
Female sex, % (n) | 21.4% (421) | |
Age, years | 64.5 ± 12.8 | |
Cardiovascular risk factors | ||
Smoking | No, % (n) | 36.6% (720) |
Former smoker | 25.3% (498) | |
Current smoker | 38.1% (749) | |
Hypertension, % (n) | 57.7% (1135) | |
Dyslipidemia, % (n) | 54.7% (1076) | |
Diabetes mellitus | No, % (n) | 72.6% (1428) |
Type I, % (n) | 0.6% (11) | |
Type II, % (n) | 26.8% (528) | |
Cardiac antecedents and comorbidities | ||
Heart failure, % (n) | 2.7% (53) | |
Coronary artery disease, % (n) | 48.0% (945) | |
PCI, % (n) | 14.2% (279) | |
Stent thrombosis, % (n) | 1.8% (36) | |
Peripheral arterial disease, % (n) | 7.8% (153) | |
Stroke, % (n) | 4.7% (93) | |
Bleeding, % (n) | 1.6% (32) | |
Active cancer, % (n) | 3.3% (65) | |
Dialysis, % (n) | 1.2% (24) | |
Cirrhosis, % (n) | 0.4% (8) | |
PEGASUS Criteria and High Bleeding Risk | ||
Meets PEGASUS criteria, % (n) | 71.8% (1400) | |
High bleeding risk, % (n) | 36.3% (715) | |
PEGASUS criterion and no high bleeding risk, % (n) | 39.5% (770) | |
Acute coronary syndrome | ||
ACS type | Unstable angina, % (n) | 12.5% (245) |
NSTEMI, % (n) | 38.0% (747) | |
STEMI, % (n) | 49.1% (965) | |
Killip > I, % (n) | 11.6% (228) | |
Coronary left main disease, % (n) | 7.0% (138) | |
Proximal LAD disease, % (n) | 33.6% (660) | |
Multivessel disease, % (n) | 52.3% (1029) | |
Incomplete revascularization, % (n) | 21.6% (424) | |
Additional tests during admission | ||
Creatinine, mg/dL | 0.80 ± 0.68 | |
Platelets, cells/μL | 227,147 ± 70,086 | |
Leukocytes, cells/μL | 10,401 ± 3614 | |
LVEF, % | 54.7 ± 9.6 | |
Complications during admission | ||
Reinfarction, % (n) | 1.1% (22) | |
Major bleeding, % (n) | 1.1% (22) | |
Heart failure, % (n) | 4.0% (79) | |
Treatment at discharge | ||
ASA, % (n) | 99.2% (1951) | |
P2Y12 inhibitor | Clopidogrel, % (n) | 30.3% (592) |
Ticagrelor, % (n) | 58.8% (1150) | |
Prasugrel, % (n) | 11.0% (215) | |
Betablockers, % (n) | 84.0% (1667) | |
ACEI or AIIRA or ARNI, % (n) | 74.3% (1461) | |
Spironolactone or eplerenone, % (n) | 6.9% (136) | |
Statins, % (n) | 97.2% (1912) |
Non-Extended DAPT 1 67.8% (n = 1333) | Extended DAPT 1 | p-Value | ||
---|---|---|---|---|
Demographics | ||||
Female sex, % (n) | 21.5% (284) | 22.1% (1037) | NS | |
Age, years | 64.4 ± 12.8 | 64.8 ± 12.9 | NS | |
Cardiovascular risk factors | ||||
Smoking | No, % (n) | 36.4% (484) | 35.8% (225) | |
Former smoker, % (n) | 23.9% (318) | 28.7% (180) | NS | |
Current smoker, % (n) | 39.6% (526) | 35.5% (223) | ||
Hypertension, % (n) | 62.8% (396) | 0.003 | ||
Dyslipidemia, % (n) | 62.1% (392) | <0.001 | ||
Diabetes mellitus | No, % (n) | 75.2% (998) | 66.9% (422) | |
Type I, % (n) | 0.3% (4) | 1.1% (7) | <0.001 | |
Type II, % (n) | 24.5% (326) | 32.0% (202) | ||
Cardiac antecedents and comorbidities | ||||
Heart failure, % (n) | 1.8% (24) | 4.6% (29) | <0.001 | |
Coronary artery disease, % (n) | 50.4% (945) | 43.9% (277) | 0.007 | |
PCI, % (n) | 10.4% (139) | 22.1% (140) | <0.001 | |
Stent thrombosis, % (n) | 0.7% (9) | 4.3% (27) | <0.001 | |
Peripheral arterial disease, % (n) | 6.4% (85) | 10.7% (68) | 0.001 | |
Stroke, % (n) | 4.1% (54) | 6.2% (39) | 0.041 | |
Bleeding, % (n) | 0.9% (12) | 0.8% (5) | NS | |
Active cancer, % (n) | 3.5% (47) | 2.9% (18) | NS | |
Dialysis, % (n) | 1.2% (16) | 1.3% (8) | NS | |
Cirrhosis, % (n) | 0.4% (5) | 0.5% (3) | NS | |
PEGASUS Criteria and High Bleeding Risk | ||||
Meets PEGASUS criteria, % (n) | 69.9% (924) | 75.8% (476) | 0.007 | |
High bleeding risk, % (n) | 36.2% (481) | 36.6% (232) | NS | |
PEGASUS criterion and no high bleeding risk, % (n) | 38.2% (505) | 42.2% (265) | NS | |
Acute coronary syndrome | ||||
ACS type | Unstable angina, % (n) | 13.3% (176) | 10.9% (69) | 0.010 |
NSTEMI, % (n) | 35.9% (476) | 42.9% (271) | ||
STEMI, % (n) | 50.8% (673) | 46.2% (292) | ||
Killip > I, % (n) | 10.2% (134) | 14.9% (94) | 0.002 | |
Coronary left main disease, % (n) | 6.1% (81) | 9.0% (57) | 0.018 | |
Proximal LAD disease, % (n) | 30.1% (401) | 41.1% (259) | <0.001 | |
Multivessel disease, % (n) | 49.3% (657) | 58.8% (372) | <0.001 | |
Incomplete revascularization, % (n) | 21.4% (286) | 22.8% (142) | NS | |
Additional tests during admission | ||||
Creatinine, mg/dL | 0.73 ± 0.70 | 0.89 ± 0.73 | <0.001 | |
Platelets, cells/μL | 225,181 ± 68,501 | 231,265 ± 72,179 | NS | |
Leukocytes, cells/μL | 10,433 ± 3637 | 10,333 ± 3567 | NS | |
LVEF, % | 54.6 ± 9.5 | 54.9 ± 9.8 | NS | |
Complications during admission | ||||
Reinfarction, % (n) | 0.5% (7) | 2.4% (15) | <0.001 | |
Major bleeding, % (n) | 0.9% (12) | 1.6% (10) | NS | |
Heart failure, % (n) | 3.5% (46) | 5.2% (33) | NS | |
Discharge treatment | ||||
ASA, % (n) | 99.3% (1320) | 98.9% (621) | NS | |
P2Y12 inhibitor | Clopidogrel, % (n) | 27.9% (371) | 35.2% (221) | 0.004 |
Ticagrelor, % (n) | 60.5% (804) | 55.1% (346) | ||
Prasugrel, % (n) | 11.6% (154) | 9.7% (61) | ||
Betablockers, % (n) | 83.3% (1105) | 87.5% (548) | 0.015 | |
ACEI or AIIRA or ARNI, % (n) | 72.3% (957) | 77.8% (487) | 0.009 | |
Spironolactone or eplerenone, % (n) | 6.3% (83) | 8.5% (53) | NS | |
Statins, % (n) | 97.1% (1289) | 97.3% (609) | NS |
OR | OR 95% CI | p-Value | |
---|---|---|---|
History of PCI | 1.847 | 1.395–2.445 | <0.001 |
History of stent thrombosis | 3.854 | 1.661–8.943 | 0.002 |
Proximal LAD stenosis | 1.444 | 1.177–1.771 | <0.001 |
Multivessel disease | 1.266 | 1.036–1.546 | 0.021 |
Reinfarction during admission | 4.117 | 1.636–10.363 | 0.003 |
Clopidogrel at discharge 1 | 1.332 | 1.081–1.641 | 0.007 |
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Bonanad, C.; Raposeiras-Roubin, S.; García-Blas, S.; Núñez-Gil, I.; Vergara-Uzcategui, C.; Díez-Villanueva, P.; Bañeras, J.; Badía Molins, C.; Aboal, J.; Carreras, J.; et al. Evaluation of the Use of Dual Antiplatelet Therapy beyond the First Year after Acute Coronary Syndrome. J. Clin. Med. 2022, 11, 1680. https://doi.org/10.3390/jcm11061680
Bonanad C, Raposeiras-Roubin S, García-Blas S, Núñez-Gil I, Vergara-Uzcategui C, Díez-Villanueva P, Bañeras J, Badía Molins C, Aboal J, Carreras J, et al. Evaluation of the Use of Dual Antiplatelet Therapy beyond the First Year after Acute Coronary Syndrome. Journal of Clinical Medicine. 2022; 11(6):1680. https://doi.org/10.3390/jcm11061680
Chicago/Turabian StyleBonanad, Clara, Sergio Raposeiras-Roubin, Sergio García-Blas, Iván Núñez-Gil, Carlos Vergara-Uzcategui, Pablo Díez-Villanueva, Jordi Bañeras, Clara Badía Molins, Jaime Aboal, Jose Carreras, and et al. 2022. "Evaluation of the Use of Dual Antiplatelet Therapy beyond the First Year after Acute Coronary Syndrome" Journal of Clinical Medicine 11, no. 6: 1680. https://doi.org/10.3390/jcm11061680
APA StyleBonanad, C., Raposeiras-Roubin, S., García-Blas, S., Núñez-Gil, I., Vergara-Uzcategui, C., Díez-Villanueva, P., Bañeras, J., Badía Molins, C., Aboal, J., Carreras, J., Bodi, V., Gabaldón-Pérez, A., Mateus-Porta, G., Parada Barcia, J. A., Martínez-Sellés, M., Chorro, F. J., & Ariza-Solé, A. (2022). Evaluation of the Use of Dual Antiplatelet Therapy beyond the First Year after Acute Coronary Syndrome. Journal of Clinical Medicine, 11(6), 1680. https://doi.org/10.3390/jcm11061680