Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly 6-030, Toronto, ON M5B 1W8, Canada.
University of Ottawa Heart Institute, Ottawa, ON, Canada.
Eur Heart J Qual Care Clin Outcomes. 2017 Oct 1;3(4):303-311. doi: 10.1093/ehjqcco/qcw051.
There is a paucity of real-world, contemporary data of practice patterns and clinical outcomes following dual-antiplatelet therapy (DAPT) in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).
The Canadian Observational Antiplatelet Study was a prospective, multicentre, cohort study examining adenosine diphosphate receptor antagonist use following PCI for AMI. We compared practice patterns, patient characteristics, and clinical outcomes in relation to DAPT duration (<6 weeks, 6 weeks to <6 months, 6 to <12, and ≥12 months). The primary outcome was the composite of non-fatal AMI, unplanned coronary revascularization, stent thrombosis, new or worsening heart failure, cardiogenic shock, or stroke. We identified 2034 patients with AMI treated with PCI. DAPT duration was <6 weeks in 5.2% of patients; 6 weeks to <6 months in 7.0%; 6 to <12 months in 12.6%; and ≥12 months in 75.3%. Patients who discontinued DAPT early had higher GRACE risk scores. Overall, mortality rate at 15 months was 2.5%. Compared with a duration of DAPT of ≥12 months, discontinuation of DAPT <6 weeks (P < 0.0001) and 6 weeks to <6 months (P = 0.02), but not 6 months to <12 months (P = 0.06), were independently associated with a higher incidence of the primary outcome among survivors.
One-in-four patients with AMI treated with PCI discontinued DAPT prior to the guideline-recommended 12-month duration. Patients in whom DAPT was discontinued early were at higher baseline risk and had higher rates of non-fatal ischaemic events during follow up.
在接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者中，双抗血小板治疗（DAPT）后实践模式和临床结局的真实世界、当代数据很少。
加拿大观察性抗血小板研究是一项前瞻性、多中心队列研究，研究了 AMI 患者 PCI 后腺苷二磷酸受体拮抗剂的使用情况。我们比较了与 DAPT 持续时间（<6 周、6 周至<6 个月、6 至<12 个月和≥12 个月）相关的实践模式、患者特征和临床结局。主要结局是非致死性 AMI、计划外冠状动脉血运重建、支架血栓形成、新发或恶化心力衰竭、心源性休克或中风的复合事件。我们确定了 2034 例接受 PCI 治疗的 AMI 患者。5.2%的患者 DAPT 持续时间<6 周；7.0%的患者 DAPT 持续时间为 6 周至<6 个月；12.6%的患者 DAPT 持续时间为 6 至<12 个月；75.3%的患者 DAPT 持续时间≥12 个月。早期停用 DAPT 的患者 GRACE 风险评分较高。总的来说，15 个月时的死亡率为 2.5%。与 DAPT 持续时间≥12 个月相比，DAPT 持续时间<6 周（P<0.0001）和 6 周至<6 个月（P=0.02），但 6 个月至<12 个月（P=0.06）与存活者主要结局发生率升高独立相关。
在接受 PCI 治疗的 AMI 患者中，四分之一的患者在指南推荐的 12 个月持续时间之前停用了 DAPT。早期停用 DAPT 的患者基线风险较高，随访期间非致死性缺血事件发生率较高。
