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Background: After a myocardial infarction (MI), dual antiplatelet therapy (DAPT) has proven beneficial to reduce the risk of thrombotic events recurrences including stent thrombosis. Because the recommended 12 month's DAPT may also expose to hemorrhagic events new scores were recently proposed to better estimate individual optimal DAPT duration. Our objectives were to identify variables associated with real life DAPT duration and then test the recently developed thrombotic and bleeding risk scores to investigate whether their use would modify patient's indication for shorter or prolonged DAPT.
Methods: This work was a multicenter, observational and retrospective study performed on the CRAC registry. All consecutive patients aged ≥18 undergoing coronary angiography or angioplasty for inaugural STEMI, in participating CathLabs of the Centre Val de Loire region in France in 2014, were systematically enrolled in the registry. All patients were recalled 13 months later to collect thrombotic and bleeding complications and to identify post-STEMI DAPT duration.
Results: Between January 1st and December 31th 2014, 493 patients were enrolled. They were divided into 2 groups according to their observed post-STEMI DAPT duration: short duration if ≤12 months (S-DAPT, n=231) and long duration if >12 months (L-DAPT, n=262). Groups baseline characteristics were comparable except for age, patients being older in the S-DAPT group (p = 0.03), number of active smokers that was higher in the L-DAPT group (p = 0.007) and use of oral anticoagulants higher in the S-DAPT group (p = 0.07). We observed that 50% of patients still had DAPT > 12 months and that systematic use of modern scores aimed at estimating individual risk may make physician reconsidering 50% of patient's optimal DAPT duration.
Conclusions: Systematic use of modern risk scores evaluating the individual risk/benefit would modify currently observed DAPT duration in half of the patients in our STEMI population with shorter or longer DAPT duration. The DAPT score was the easiest score to use requiring clinical data usually available in medical consultation.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-141
- 2017 American College of Cardiology Foundation