Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy

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• 作者：Akshay Bagai^a ; ¹ ; ^{bagaia@smh.ca} ; Tracy Y. Wang^b ; ¹ ; Shaun G. Goodman^a ; ^c ; ¹ ; Harold N. Fisher^d ; ¹ ; Robert C. Welsh^e ; ¹ ; Jean-Pierre Dery^f ; ¹ ; Xiang Zhang^g ; ¹ ; Yajun E. Zhu^g ; ¹ ; Asim N. Cheema^a ; ¹ ; Payam Dehghani^h ; ¹ ; Saleem A. Kassamⁱ ; ¹ ; John Ducas^j ; ¹ ; Neil Brass^k ; ¹ ; Hahn Hoe Kim^l ; ¹ ; Anthony Fung^m ; ¹ ; Erick Schampaertⁿ ; ¹ ; Ata ur Rehman Quraishi^o ; ¹ ; Shamir R. Mehta^p ; ¹ ; for the Canadian Observational AntiPlatelet sTudy (COAPT) Investigators
• 关键词：ADP receptor inhibitors ; Myocardial infarction ; Percutaneous coronary intervention
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：459-464
• 全文大小：345 K
• 卷排序：228

文摘

After myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor inhibitor (ADPri) for at least 1 year. However, whether real-world Canadian practice patterns reflect this recommendation is unknown.MethodsWe studied 2175 MI patients treated with PCI and discharged from 26 Canadian hospitals between 12/2011 and 05/2013 in the Canadian Observational Antiplatelet sTudy (COAPT). Hierarchical Cox proportional hazard regression modeling was used to determine baseline demographic and clinical factors associated with duration of ADPri therapy post-discharge.ResultsAt index-hospitalization discharge, 1597 (73%) patients were treated with clopidogrel, 220 (10%) with prasugrel, and 358 (17%) with ticagrelor. ADPri was discontinued prior to 1 year in 474 (21.8%) patients; discontinuation rates were lowest for patients discharged on prasugrel (17.7%), compared with clopidogrel (22.5%) or ticagrelor (21.0%), (log rank test, p = 0.03). In addition to regional variability, factors associated with shorter ADPri duration included older age, low body weight, Killip III/IV heart failure, atrial fibrillation, ticagrelor on discharge, and bare metal stent use, while longer ADPri duration was associated with history of prior MI.ConclusionsOne in five PCI-treated MI patients did not complete Canadian guideline-recommended 1-year course of ADPri treatment. Premature ADPri discontinuation was most strongly associated with factors that increase the risk of bleeding. Further study is required to assess the clinical implications of premature ADPri discontinuation on patient outcomes.