Key result
Extended dual antiplatelet therapy for more than 24 months reduced the risk of all-cause mortality compared to 12-24 months of therapy in AMI survivors meeting PEGASUS-TIMI 54 criteria.
Why the study?
The effectiveness of extended DAPT beyond 24 months after second-generation DES implantation in high-ischemic-risk AMI survivors without prior major bleeding was evaluated.
Does extended DAPT over 24 months reduce mortality in post-AMI 2-year survivors meeting PEGASUS-TIMI 54 criteria without prior major bleeding?
Cohort (n=3,382)
Yes
Does extended DAPT over 24 months reduce mortality in post-AMI 2-year survivors meeting PEGASUS-TIMI 54 criteria without prior major bleeding?
Answers are grounded in this paper and cite their sources.
Extended DAPT beyond 24 months in high-risk post-AMI patients without prior bleeding is associated with reduced all-cause mortality without significantly increasing major bleeding.
Background We evaluated the effectiveness of extended dual antiplatelet therapy (DAPT) usage after 2nd-generation drug elution stent implantation in acute myocardial infarction (AMI) survivors with high ischemic risk characteristics who had no major bleeding for 24 months under at least 1 year of DAPT maintenance. Materials and methods The primary ischemic and bleeding endpoints were the risk of mortality and the risk of BARC 3 or 5 (major) bleeding. We investigated the event rates for 2–5 years after the index procedure. Results Of 3382 post-AMI survivors who met the PEGASUS-TIMI 54 (PEGASUS) criteria and without major bleeding until 2 years, 2281 (67.4%) maintained DAPT over 24 months, and 1101 (32.5%) switched DAPT to a single antiplatelet agent. The >24 M DAPT group showed a lower risk of mortality than the 12–24 M DAPT group (7.2 vs. 9.2%; adjusted hazard ratio: 0.648; 95% confidence interval: 0.595–0.976; p < 0.001). The mortality risk was significantly greater as the number of PEGASUS criteria increased ( p < 0.001). DAPT > 24 months was not significantly associated with a decreased risk for major bleeding in the population meeting the PEGASUS criteria (2.0 vs. 1.1%; p = 0.093). The results were consistent after propensity-score matching and inverse probability weighting to adjust for baseline differences. Conclusion Extended DAPT over 24 months was associated with a lower risk of mortality without increasing the risk of major bleeding among 2 years survivors after AMI who met the PEGASUS criteria and had no major bleeding events before 24 months.
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Lee et al. (2022) conducted a cohort in Acute Myocardial Infarction (AMI) with PEGASUS-TIMI 54 criteria (n=3,382). Extended dual antiplatelet therapy (DAPT > 24 months) vs. Single antiplatelet therapy (SAPT) switched between 12 and 24 months was evaluated on All-cause mortality (HR 0.648, 95% CI 0.504-0.835, p=<0.001). Extended dual antiplatelet therapy for more than 24 months reduced the risk of all-cause mortality compared to 12-24 months of therapy in AMI survivors meeting PEGASUS-TIMI 54 criteria.
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