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Dual antiplatelet therapy duration in patients with acute coronary syndrome treated with percutaneous coronary intervention: how do we make decisions?
Session:
Posters (Sessão 5 - Écran 4) - Síndromes Coronárias Agudas - tratamento farmacológico
Speaker:
Joana Certo Pereira
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joana Certo Pereira; João Presume; Catarina Brízido; Jorge Ferreira; Daniel A. Gomes; Rita Carvalho; Miguel Domingues; Marisa Trabulo; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong>International guidelines recommend at least 12 months of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes (ACS), with the possibility of extension beyond 12 months in patients with low bleeding risk. However, the selection of patients who benefit the most from DAPT extension is often a topic of debate among clinicians. The use of clinical and technical aspects associated with increased thrombotic risk, as well as risk scores (e.g. DAPT score; Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria) may be considered for decisions. We aimed to assess how DAPT duration is managed in real-world clinical practice.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-center retrospective study including consecutive patients admitted for ACS at a tertiary center, from 2016 to 2018. All patients were evaluated at 1-year follow-up regarding the decision on extended treatment (ET) or standard treatment (ST). For those undergoing percutaneous coronary intervention (PCI), clinical and technical aspects associated with <span style="color:black">increased thrombotic risk, as well as 2 recommended risk scores (DAPT score and ARC-HBR score) were evaluated. Patients under anticoagulation were excluded.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">A total of 423 patients were included - mean age was 63±14 years, 70% (n=297) were male and clinical presentation was STEMI in 54% (n=229). Overall, 5% (n=22) underwent CABG, 91% (n=384) underwent PCI, and 4% (n=17) medical therapy, and from the whole population, 35% (n=147) remained on ET. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">For PCI-treated patients, the mean DAPT score was 1,7</span><span style="color:black">±</span><span style="color:black">1,0 and 43% (n=166) patients had high-bleeding risk according to ARC-HBR criteria. Thirty-three percent of PCI patients (n=126) were under ET. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">DAPT score, age, polyvascular disease, multivessel disease, presence of more than 3 stents, and previous myocardial infarction were individual predictors of ET – table 1. Moreover, all patients who had stent thrombosis remained on ET. On the other hand, high bleeding risk according to ARC-HBR, and anemia were predictors for ST.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">After multivariate logistic regression, only polyvascular disease remained significantly associated with ET (OR 3.193 [1.003; 10.165]; p=0.049) and anemia with ST (OR 0.378 [0.166; 0.861]; p=0.021). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusions: </span></strong><span style="color:black">In this real-world ACS population, 30% of patients continued DAPT for longer than 1 year. For those undergoing PCI, besides stent thrombosis, and after adjusting for multiple clinical and technical aspects associated with increased thrombotic risk, only polyvascular disease was a predictor of longer DAPT, while anemia was a predictor of standard therapy. The optimal duration of DAPT following PCI is still up for debate and a perfect tool is yet to come. </span></span></span></p>
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