Abstract
BackgroundCurrent guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI).HypothesisWe sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year.MethodsWe analyzed data from the EYESHOT Post‐MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event.ResultsOut of the 1633 post‐MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit.ConclusionsRisk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI.
Highlights
Current guidelines suggest that continuation of dual antiplatelet therapy (DAPT) for longer than 12 months should be considered in patients with myocardial infarction (MI) who have tolerated DAPT without bleeding complications.[1,2]
Patients on DAPT had less frequently atrial fibrillation (6.8% vs 15.9%, P < .0001) but did have a higher incidence of peripheral artery disease (PAD) compared to patients without DAPT at enrolment (9.3% vs 5.6%, P = .005)
The present analysis of a nationwide study on consecutive patients managed by cardiologists 1-3 years after a MI demonstrates that: (a) DAPT was withdrawn in approximately one of three patients enrolled and in less than 5% of cases DAPT was initiated after cardiologist' assessment; (b) Risk scores for the identification of patients who can benefit from DAPT prolongation are mis- and underused in clinical practice; (c) Patients with a complex percutaneous coronary intervention (PCI) and a history of PAD are those who more frequently continue DAPT beyond 1 year from the index MI
Summary
Using data from the EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTaly) Post-MI study[12] we sought to evaluate the criteria used by cardiologists in daily clinical practice for selecting post-MI patients eligible for DAPT continuation beyond 1 year. Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. A percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI
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