Key result
Dual antiplatelet therapy interruption within 1 year after primary percutaneous coronary intervention for STEMI occurred in 17.1% of survivors, with age being the only independent predictor.
Why the study?
DAPT is recommended for 1 year after PPCI for STEMI, but interruptions may occasionally be required for bleeding issues or unplanned surgical procedures.
Observational (n=538)
No
DAPT interruption within 1 year after PPCI for STEMI is common, occurring in 17.1% of survivors, highlighting the need for careful stent selection particularly in elderly patients.
DAPT interruption is common after STEMI PCI, especially with advanced age; leaves open optimal individualized regimens pending prospective trials.
BACKGROUND: After primary percutaneous coronary intervention (PPCI) in patients with acute ST elevation myocardial infarction (STEMI), dual antiplatelet therapy (DAPT) is recommended to continue for 1 year. Occasionally, DAPT interruption may be required due to bleeding issues or unplanned surgical procedures. OBJECTIVE: To systematically evaluate the incidence of DAPT interruption within 1 year after PPCI. METHODS AND RESULTS: This was a single-centre, retrospective registry study. Consecutive patients with STEMI who underwent PPCI from 2013 to 2017 (N=538) were recruited into the analysis. The primary outcome was the incidence of interruption of DAPT within 1 year from the index PPCI. Secondary outcomes included incidence of bleeding in 1 year and prevalence of high bleeding risk (HBR) criteria at index presentation. Within 1 year, 17.1% (84/490) of post-PPCI survivors needed DAPT interruption and 7.1% (35/490) had major bleeding (Bleeding Academic Research Consortium type 3 or 5). At index presentation, HBR criteria were present in 36.1% (194/538) of patients. On univariate analysis, age, female gender, anaemia, anticoagulation, diabetes, hypertension and being a non-smoker were associated with DAPT interruption. On multivariate analysis, age was the only independent factor to predict DAPT interruption. CONCLUSION: DAPT interruption was not uncommon after PPCI in patients with STEMI particularly in the elderly. This has implication on stent selection during PPCI, and further studies are required to investigate which type of stent may best suit our real-life patients with STEMI.
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Tam et al. (2019) conducted an observational in Acute ST elevation myocardial infarction (STEMI) (n=538). Dual antiplatelet therapy (DAPT) was evaluated on Incidence of interruption of DAPT within 1 year from the index PPCI. Dual antiplatelet therapy interruption within 1 year after primary percutaneous coronary intervention for STEMI occurred in 17.1% of survivors, with age being the only independent predictor.
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