• Cardiology Clinical Trials
• Coronary Artery Disease

• Cardiology Clinical Trials
• Coronary Artery Disease
• Cardiology

For patients discharged after acute coronary syndrome (ACS), changing from dual-antiplatelet therapy (DAPT) to less potent antiplatelet therapy is not associated with increased coronary or mortality risk despite a short-term excess of cardiovascular (CV) events.

Héctor Bueno, MD, PhD, Hospital General Universitario Gregorio Maranon, Madrid, Spain, presented the results of the Long-term Follow-up of Anti-thrombotic Management Patterns in Acute Coronary Syndrome Patients [EPICOR; NCT01171404], a real-world-practice cohort study conducted to describe current international patterns of DAPT use following ACS and the clinical outcomes associated with changes in DAPT.

Between September 2010 and March 2011, patients (n = 10 568) from 555 hospitals in 20 countries across Latin America and Europe were enrolled in the study. All patients were hospitalized for an ACS within 24 hours of symptom onset, and all survived to hospital discharge. Of these patients, 4943 had STEMI, and 5625 had non-ST segment elevation ACS.

This prospective, observational study was designed to look at short- and long-term antithrombotic management patterns in patients with ACS among the hospitals. It also examined the relationship between antithrombotic management patterns and in-hospital and postdischarge clinical outcomes, quality of life, and economic aspects.

At discharge, the medication status was known for 10 069 patients; 8593 (85.3%) remained on DAPT, while others switched to single-antiplatelet therapy or oral anticoagulation. At 2 years, 43.8% of patients remained on DAPT.

Prof Bueno said that the data show that patients frequently remained on DAPT after ACS much longer than the recommendation guidelines of 12 months. The study found that a maximum of 65.9% of patients in Latin America and a minimum of 55.7% in Southern Europe remained on DAPT at 2 years (P < .001).

To look at the association between change in DAPT status and clinical outcomes, Prof Bueno presented the 2-year follow-up results of 8593 patients who were interviewed per study design every 3 months after discharge up to 24 months. Results at 2 years showed an increase in CV events in patients who discontinued DAPT versus those who remained on DAPT. Despite the increase in nonfatal CV events, there was no association with changes in DAPT status and the risk of either coronary or all-cause mortality, although there were few number of events (Tables 1 and 2).

Prof Bueno highlighted several limitations of the study, including its observational nature, potential for recall bias, lack of accurately recording the date of all medication changes, few number of deaths, potential to underestimate CV events, and lack of systematic recording of the cause of death.

• © 2014 MD Conference Express®