Long versus short dual antiplatelet therapy in acute coronary syndrome patients treated with prasugrel or ticagrelor and coronary revascularization: Insights from the RENAMI registry.

Autor:	D'Ascenzo F; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Bertaina M; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Fioravanti F; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Bongiovanni F; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Raposeiras-Roubin S; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Abu-Assi E; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Kinnaird T; Cardiology Department, University Hospital of Wales, Cardiff, UK., Ariza-Solé A; Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain., Manzano-Fernández S; Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain., Templin C; University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland., Velicki L; Medical faculty, University of Novi Sad, Novi Sad, Serbia and Institute of cardiovascular diseases Vojvodina, Sremska Kamenica, Serbia., Xanthopoulou I; University Patras Hospital, Athens, Greece., Cerrato E; Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy., Rognoni A; Catheterization Laboratory, Maggiore della Carità Hospital, Novara, Italy., Boccuzzi G; Department of Cardiology, S.G. Bosco Hospital, Torino, Italy., Omedè P; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Montabone A; Department of Cardiology, S.G. Bosco Hospital, Torino, Italy., Taha S; Department of Cardiology, Faculty of Medicine, Assiut University, Egypt., Durante A; U.O. Cardiologia, Ospedale Valduce, Como, Italy., Gili S; University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland., Magnani G; University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland., Autelli M; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Grosso A; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Blanco PF; Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain., Garay A; Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain., Quadri G; Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy., Varbella F; Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy., Queija BC; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Paz RC; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Fernández MC; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Pousa IM; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Gallo D; PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy., Morbiducci U; PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy., Dominguez-Rodriguez A; Department of Cardiology, University Hospital from Canarias, Santa Cruz de Tenerife, Spain., Valdés M; Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain., Cequier A; Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain., Alexopoulos D; University Patras Hospital, Athens, Greece., Iñiguez-Romo A; Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain., Gaita F; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Rinaldi M; Department of Cardiology, Department of Medical Sciences, University of Torino, Italy., Lüscher TF; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK.
Jazyk:	angličtina
Zdroj:	European journal of preventive cardiology [Eur J Prev Cardiol] 2020 May; Vol. 27 (7), pp. 696-705. Date of Electronic Publication: 2019 Mar 12.
DOI:	10.1177/2047487319836327
Abstrakt:	Introduction: The benefits of short versus long-term dual antiplatelet therapy (DAPT) based on the third generation P2Y12 antagonists prasugrel or ticagrelor, in patients with acute coronary syndromes treated with percutaneous coronary intervention remain to be clearly defined due to current evidences limited to patients treated with clopidogrel. Methods: All acute coronary syndrome patients from the REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) undergoing percutaneous coronary intervention and treated with aspirin, prasugrel or ticagrelor were stratified according to DAPT duration, that is, shorter than 12 months (D1 group), 12 months (D2 group) and longer than 12 months (D3 group). The three groups were compared before and after propensity score matching. Net adverse clinical events (NACEs), defined as a combination of major adverse cardiac events (MACEs) and major bleedings (including therefore all cause death, myocardial infarction and Bleeding Academic Research Consortium (BARC) 3-5 bleeding), were the primary end points, MACEs (a composite of all cause death and myocardial infarction) the secondary one. Single components of NACEs were co-secondary end points, along with BARC 2-5 bleeding, cardiovascular death and stent thrombosis. Results: A total of 4424 patients from the RENAMI registry with available data on DAPT duration were included in the model. After propensity score matching, 628 patients from each group were selected. After 20 months of follow up, DAPT for 12 months and DAPT for longer than 12 months significantly reduced the risk of NACE (D1 11.6% vs . D2 6.7% vs . D3 7.2%, p  = 0.003) and MACE (10% vs . 6.2% vs . 2.4%, p  < 0.001) compared with DAPT for less than 12 months. These differences were driven by a reduced risk of all cause death (7.8% vs . 1.3% vs . 1.6%, p  < 0.001), cardiovascular death (5.1% vs . 1.0% vs . 1.2%, p  < 0.0001) and recurrent myocardial infarction (8.3% vs . 5.2% vs . 3.5%, p  = 0.002). NACEs were lower with longer DAPT despite a higher risk of BARC 2-5 bleedings (4.6% vs . 5.7% vs . 6.2%, p  = 0.04) and a trend towards a higher risk of BARC 3-5 bleedings (2.4% vs . 3.3% vs . 3.9%, p  = 0.06). These results were not consistent for female patients and those older than 75 years old, due to an increased risk of bleedings which exceeded the reduction in myocardial infarction. Conclusion: In unselected real world acute coronary syndrome patients treated with percutaneous coronary intervention, DAPT with prasugrel or ticagrelor prolonged beyond 12 months markedly reduces fatal and non-fatal ischaemic events, offsetting the increased risk deriving from the higher bleeding risk. On the contrary, patients >75 years old and female ones showed a less favourable risk-benefit ratio for longer DAPT due to excess of bleedings.
Databáze:	MEDLINE
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