Key result
In patients with acute coronary syndrome undergoing percutaneous coronary intervention, dual antiplatelet therapy for >9 months was associated with a significantly lower risk of the primary composite outcome compared to ≤9 months (OR 0.725).
Why the study?
Little information is available in Asia about the real-world practice of DAPT duration for ACS and its influence on clinical outcomes.
Does clopidogrel-based dual antiplatelet therapy for >9 months reduce cardiovascular death, myocardial infarction, and stroke in acute coronary syndrome patients undergoing percutaneous coronary intervention compared to ≤9 months?
Observational (n=2,221)
Yes
Does clopidogrel-based dual antiplatelet therapy for >9 months reduce cardiovascular death, myocardial infarction, and stroke in acute coronary syndrome patients undergoing percutaneous coronary intervention compared to ≤9 months?
In a real-world Taiwanese registry, continuing clopidogrel-based DAPT for >9 months after PCI for ACS was associated with a significantly lower risk of ischemic events compared to shorter durations.
Answers are grounded in this paper and cite their sources.
DAPT ≤9 months was associated with higher ischemic risk in Taiwanese ACS patients; leaves open optimal duration in real-world Asian practice.
BACKGROUND: Little information is available in Asia about the real-world practice of dual antiplatelet therapy (DAPT) duration for acute coronary syndrome (ACS) and its influence on clinical outcomes. METHODS AND RESULTS: The Taiwan ACS STENT Registry was a prospective, multicenter study to observe ACS patients using clopidogrel-based DAPT after percutaneous coronary intervention (PCI). The primary outcome was a composite of cardiovascular death, myocardial infarction, and stroke. Overall, 2,221 ACS patients (62 years, 83% men) were included. DAPT duration was ≤9 months in 935 (42.1%). The incidence of primary outcome was higher in patients receiving DAPT ≤9 months compared with those receiving DAPT >9 months at 1 year (3.5% vs. 1.6%, P=0.0026). The incidence of stent thrombosis (overall 0.5%) was similar between groups. Multivariable analysis showed that DAPT >9 months was associated with a significantly lower risk of primary outcome (odds ratio 0.725, 95% confidence interval 0.545-0.965). CONCLUSIONS: Our data showed that short duration of DAPT (≤9 months) was common (42.1%) in Taiwan for ACS patients undergoing PCI. DAPT ≤9 months increased the risk of the primary outcome.
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Li et al. (2019) conducted an observational in Acute Coronary Syndrome (n=2,221). Dual antiplatelet therapy >9 months vs. Dual antiplatelet therapy ≤9 months was evaluated on Composite of cardiovascular death, myocardial infarction, and stroke at 1 year (OR 0.725, 95% CI 0.545-0.965, p=0.0026). In patients with acute coronary syndrome undergoing percutaneous coronary intervention, dual antiplatelet therapy for >9 months was associated with a significantly lower risk of the primary composite outcome compared to ≤9 months (OR 0.725).
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