Abstract
Introduction: Data on P2Y12 inhibitor (single agent) use in percutaneous coronary intervention (PCI) is sparse. Hypothesis: Long term outcomes in patients undergoing PCI with only P2Y12 inhibitors vs. dual antiplatelet therapy (DAPT). Methods: We used PCI registry of Guthrie clinic system from the year 2001 to 2012. We identified patients discharged only on P2Y12 inhibitors (Plavix, Ticagrelor, Prasugrel) due to aspirin allergy. We created propensity score using patient demographics (age, gender), risk factors (hypertension, diabetes, hyperlipidemia etc.), medications detail (statin, B blocker etc.) and catheterization detail (vessel involved, type of stent and culprit vessel etc.) for patients discharged only on P2Y12 inhibitors vs DAPT. Propensity score match (1:100) analysis was conducted using greedy’s method for adjusting confounders. The primary outcome was MACE(myocardial infarction(MI), stroke, death, coronary artery occlusion) up to 8 years and secondary outcomes were death and recurrent myocardial infarction(MI) up to 8 years. Sensitivity analysis was done using Cox-proportional hazard regression. Results: 7742 patients with successful intervention were identified during the study period. Out of which, 43(0.65%) had aspirin allergy and received only P2Y12 inhibitor. Hyperlipidemia (78.8%), hypertension (72.8%), obesity (48.7%) and diabetes (31.6%) were most common risk factors. >90% patients were on optimum medical treatment. 59% of patients received drug-eluting stent/s and 17.5% patients underwent multivessel PCI. Right coronary artery(37.6%) and left anterior descending artery(35.8%) were commonest culprit vessels. Median follow up period was 1828 days (~ 5 years). After adjusting with propensity score match, primary outcome (HR:1.73, 95% CI: 1.17-2.67, p-0.005) and secondary outcomes (MI: HR: 2.46, 95% CI:1.28-4.51, p-0.005), (death: HR:1.85, 95% CI:1.09-2.23, p-0.023) were higher in patients discharged only on P2Y12 inhibitors. Sensitivity analysis showed similar results. Conclusions: Only P2Y12 inhibitor was inferior to DAPT in patients undergoing PCI. Future clinical trials will be needed to reinforce our findings.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
