Key result
Prolonging dual antiplatelet therapy to at least 18 months significantly reduced the risk of 24-month all-cause death (HR 0.59) compared to 12-month therapy in AMI patients without revascularization.
Why the study?
Data on prolonged dual antiplatelet therapy (DAPT) for acute myocardial infarction patients without revascularization are limited.
Does prolonged dual antiplatelet therapy (≥18 months) reduce 24-month all-cause death in AMI patients without revascularization who are event-free at 12 months compared to 12-18 months of DAPT?
Observational (n=1,744)
Yes
Does prolonged dual antiplatelet therapy (≥18 months) reduce 24-month all-cause death in AMI patients without revascularization who are event-free at 12 months compared to 12-18 months of DAPT?
Answers are grounded in this paper and cite their sources.
Prolonged DAPT (≥18 months) is associated with reduced 24-month all-cause mortality in AMI patients managed without revascularization who remain event-free at 12 months.
Background At least 12-month dual antiplatelet therapy (DAPT) is one of the standards of care following Percutaneous Coronary Intervention (PCI) in patients with acute coronary syndrome. However, study on prolonged DAPT for acute myocardial infarction (AMI) patients without revascularization is limited. Methods We studied 1744 AMI patients without revascularization from the China Acute Myocardial Infarction registry between January 2013 and September 2014. These patients were on DAPT and did not experience AMI, stroke, or bleeding events at 12-month follow-up. We divided them into two groups: 12-month DAPT group (DAPT for at least 12 months but less than 18 months) and 18-month DAPT group (DAPT for at least 18 months). The primary outcome is 24-month all-cause death. Results Overall, 1221 (70.0%) patients took DAPT for ≥12 months but <18 months, while 523 (30.0%) patients took DAPT for ≥18 months. The two groups had comparable proportions with high ischemic risk (27.0% vs. 25.6%, P = 0.5418), as well as high bleeding risk (29.0% vs. 28.5%, P = 0.8316). At 24 months, the all-cause mortality rate of 18-month DAPT group was significantly lower than that for 12-month DAPT group (3.7% vs 5.9%, P = 0.0471). Adjusted hazard ratio for all-cause death also showed statistical significance (0.59, 95% CI: 0.35-0.99, P = 0.0444). Conclusions DAPT for at least 18 months was associated with lower 24-month mortality for non-revascularization AMI patients without events within 12 months after onset.
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Huang et al. (2023) conducted an observational in Acute Myocardial Infarction without revascularization (n=1,744). Prolonged Dual Antiplatelet Therapy (≥18 months) vs. 12-month Dual Antiplatelet Therapy (≥12 to <18 months) was evaluated on 24-month all-cause death (HR 0.59, 95% CI 0.35-0.99, p=0.0444). Prolonging dual antiplatelet therapy to at least 18 months significantly reduced the risk of 24-month all-cause death (HR 0.59) compared to 12-month therapy in AMI patients without revascularization.
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