Use of modern scores to evaluate individual risk/benefit of prolonged Dual AntiPlatelet Therapy may modify Dual AntiPlatelet Therapy duration in ST-segment elevation myocardial infarction patients

Abstract

After a myocardial infarction (MI), dual antiplatelet therapy (DAPT) has proven beneficial to reduce the risk of thrombotic events recurrences. Because the recommended 12-month's DAPT may also expose to hemorrhagic events new scores were recently proposed to better estimate individual optimal DAPT duration. To identify variables associated with real life DAPT duration and then test the recently developed thrombotic and bleeding risk scores to investigate whether their use would modify patient's indication for shorter or prolonged DAPT. This work was a multicenter, observational and retrospective study performed on the CRAC registry. All consecutive patients aged ≥ 18 undergoing coronary angiography or angioplasty for inaugural STEMI, in participating CathLabs of the Centre Val-de-Loire region in France in 2014, were enrolled in the registry. All patients were recalled 13 months later to collect thrombotic and bleeding complications and to identify post-STEMI DAPT duration. Between January 1st and December 31st 2014, 493 patients were enrolled. They were divided into 2 groups according to their observed post-STEMI DAPT duration: short duration if ≤ 12 months (S-DAPT, n = 231) and long duration if > 12 months (L-DAPT, n = 262). Groups baseline characteristics were comparable except for age, patients being older in the S-DAPT group ( P = 0.03), number of active smokers that was higher in the L-DAPT group ( P = 0.007) and use of oral anticoagulants higher in the S-DAPT group ( P = 0.07). We observed that 50% of patients still had DAPT > 12 months and that systematic use of modern scores aimed at estimating individual risk may make physician reconsidering 50% of patient's optimal DAPT duration. Systematic use of modern risk scores evaluating the individual risk/benefit would modify currently observed DAPT duration in half of the patients in our STEMI population with shorter or longer DAPT duration.