Bueno Héctor, Pocock Stuart, Danchin Nicolas, Annemans Lieven, Gregson John, Medina Jesús, Van de Werf Frans
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de investigación i+12.
Heart. 2017 Jan 15;103(2):132-138. doi: 10.1136/heartjnl-2016-309509. Epub 2016 Aug 8.
To describe international patterns of dual antiplatelet therapy (DAPT) duration after acute coronary syndrome (ACS), and explore its determinants and correlation with clinical events.
EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients) is a prospective, international, observational study of 10 568 ACS hospital survivors enrolled in 555 centres from 20 countries across Europe and Latin America between 2010 and 2011, with telephone follow-up at quarterly intervals up to 24 months to assess treatment continuation and clinical events.
Of 8593 patients discharged on DAPT, 4859 (57%) remained on uninterrupted DAPT at end of follow-up. There were minor differences in rates of DAPT discontinuation according to age, gender, risk factors, therapeutic strategy or region, but major differences between countries. By study end, 555 of evaluable patients (5.7%) died, 727 (10.0%) experienced new cardiovascular (CV) events, 496 new coronary events (6.82%) and 154 (2.11%) clinically relevant bleeding (14 (6.7%) fatal). Most CV events and deaths (85%) occurred while on DAPT. DAPT interruption was associated with increased risk of CV events in the following week (HR 2.29; 95% CI 1.08 to 4.84) but not specifically with time to first coronary event or mortality.
Despite guideline recommendations, most patients with ACS in Europe and Latin America remained on DAPT beyond 12 months, country being the most important determinant of DAPT duration. Increase in short-term CV risk was seen after switching from DAPT to less medication, as compared with continued DAPT, with no long-term effect on coronary or mortality risk.
NCT01171404; Results.
描述急性冠脉综合征（ACS）后双联抗血小板治疗（DAPT）疗程的国际模式，并探讨其决定因素以及与临床事件的相关性。
EPICOR（急性冠脉综合征患者抗血栓管理模式的长期随访）是一项前瞻性、国际性、观察性研究，纳入了2010年至2011年间来自欧洲和拉丁美洲20个国家555个中心的10568例ACS住院幸存者，每季度进行电话随访，最长随访24个月，以评估治疗持续情况和临床事件。
在8593例出院时接受DAPT治疗的患者中，4859例（57%）在随访结束时仍持续接受不间断的DAPT治疗。根据年龄、性别、危险因素、治疗策略或地区，DAPT停药率存在细微差异，但国家之间存在重大差异。到研究结束时，555例可评估患者（5.7%）死亡，727例（10.0%）发生新的心血管（CV）事件，496例发生新的冠脉事件（6.82%），154例（2.11%）发生具有临床意义的出血（14例（6.7%）为致命性出血）。大多数CV事件和死亡（85%）发生在接受DAPT治疗期间。DAPT中断与接下来一周内CV事件风险增加相关（HR 2.29；95%CI 1.08至4.84），但与首次冠脉事件发生时间或死亡率无特定关联。
尽管有指南推荐，但欧洲和拉丁美洲的大多数ACS患者接受DAPT治疗的时间超过了12个月，国家是DAPT疗程的最重要决定因素。与持续接受DAPT治疗相比，从DAPT转换为较少药物治疗后，短期CV风险增加，对冠脉风险或死亡率无长期影响。
NCT01171404；结果
