Key result
Dual antiplatelet prescription declined from 61.8% at discharge to 12.6% at 12 months, although treatment for ≥9 months was associated with lower 1-year mortality.
Why the study?
Does dual antiplatelet treatment for 9 months or longer reduce 1-year mortality in patients with unstable angina or NSTEMI?
Observational (n=1,331)
Yes
Does dual antiplatelet treatment for 9 months or longer reduce 1-year mortality in patients with unstable angina or NSTEMI?
Adherence to dual antiplatelet therapy for at least 9 months in ACS patients is associated with lower 1-year mortality, though real-world prescription rates decline rapidly due to physician judgment.
DAPT for ≥9 months was associated with lower ACS mortality in this cohort; leaves open whether RCTs would confirm benefit or show selection bias.
BACKGROUND: Benefits of antiplatelet agents in preventing future cardiovascular events have been well established. However, the prescription pattern of antiplatelet usage in patients with acute coronary syndrome (ACS) is rarely investigated. Hence, Taiwan ACute CORonary Syndrome Descriptive Registry (T-ACCORD Registry) aimed to evaluate medical practices in Taiwan in managing ACS patients. HYPOTHESIS: The guidelines of antiplatelet treatment is not properly implanted in the management of ACS patients. METHODS: This prospective observational study was performed between April 2004 and December 2006 in 27 hospitals in Taiwan. A total of 1331 patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI) discharged from hospitals was analyzed. RESULTS: The patients with older age, lower hemoglobin levels, or previous cardiovascular ischemic diseases were less likely to receive aspirin at discharge, whereas patients with NSTEMI were less likely to receive clopidogrel at discharge. The prescription of dual antiplatelet agents declined rapidly from 61.8% at discharge to 12.6% at 12 months. The most common reason for clopidogrel discontinuation was recorded as physician's judgment. Dual antiplatelet treatment for 9 months or longer was associated with lower 1-year mortality. Percutaneous coronary intervention (PCI) was the only factor leading to dual antiplatelet therapy for at least 9 months. CONCLUSIONS: Our registry showed that underlying medical conditions may affect antiplatelet prescriptions at discharge. During the first year following an ACS episode, the prescription rate of dual antiplatelet therapy declined over time, mainly due to physician's judgment leading to the discontinuation of clopidogrel. Adherence to dual antiplatelet treatment was associated with lower total mortality at 1 year.
No takes yet. Share an insight, caveat, or question.
Cheng et al. (2010) conducted an observational in Acute coronary syndrome (unstable angina or NSTEMI) (n=1,331). Dual antiplatelet therapy was evaluated on 1-year mortality. Dual antiplatelet prescription declined from 61.8% at discharge to 12.6% at 12 months, although treatment for ≥9 months was associated with lower 1-year mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: