Dual antiplatelet therapy was associated with similar rates of thromboembolic events (5% vs 6.8%, P=0.70) and bleeding (2.5% vs 9.1%, P=0.18) compared to triple therapy after PCI for anterior STEMI.
Cohort (n=124)
Does dual antiplatelet therapy compared to triple antithrombotic therapy prevent thromboembolic events and reduce bleeding in patients post-PCI for anterior STEMI with LVEF ≤35%?
In patients with anterior STEMI and LVEF ≤35% undergoing PCI, DAPT showed similar rates of thromboembolic events and numerically lower bleeding compared to triple therapy, challenging the routine use of warfarin in this population.
Absolute Event Rate: 5% vs 6.8%
p-value: p=0.70
Current guidelines recommend triple antithrombotic therapy (TT) consisting of warfarin, aspirin, and a P2Y12 inhibitor following an anterior ST elevation myocardial infarction (STEMI) complicated by extensive wall motion abnormalities. This recommendation, however, is based on data collected before percutaneous coronary intervention (PCI) became the standard of care for the treatment of STEMI. We designed a retrospective study of patients who received PCI for anterior STEMI over an 8-year period to compare rates of thromboembolic and bleeding events between patients receiving dual antiplatelet therapy (DAPT) and those receiving TT, including warfarin. Patients were included if the predischarge echocardiogram showed extensive wall motion abnormality and an ejection fraction ≤35%. Patients with known left ventricular thrombus were excluded. A total of 124 patients met the criteria, with 80 patients in the DAPT group and 44 in the TT group. The median age was 58 years in the TT group and 64 years in the DAPT group (P < 0.04), with an average ejection fraction of 31%. Thromboembolic events occurred in 4 patients (5%) in the DAPT group compared with 3 patients (6.8%) in the TT group (P = 0.70). Bleeding occurred in 2 patients in the DAPT group and 4 patients in the TT group (2.5% in DAPT vs. 9.1% in TT group, P = 0.18). No differences in rates of clinical embolism or left ventricular thrombus were found. Our data support recent findings that warfarin may not be indicated for patients following PCI for anterior STEMI, even when significant wall motion abnormalities and reduced ejection fraction ≤35% are present.
Oyetayo et al. (2015) conducted a cohort in Anterior STEMI with depressed LVEF (n=124). Dual antiplatelet therapy (DAPT) vs. Triple antithrombotic therapy (TT) was evaluated on Thromboembolic events (p=0.70). Dual antiplatelet therapy was associated with similar rates of thromboembolic events (5% vs 6.8%, P=0.70) and bleeding (2.5% vs 9.1%, P=0.18) compared to triple therapy after PCI for anterior STEMI.