Department of Cardiology, Peking University First Hospital, Beijing, China.
Department of Medicine, Queen Mary Hospital, Hong Kong, SAR, China.
Clin Cardiol. 2020 Sep;43(9):999-1008. doi: 10.1002/clc.23400. Epub 2020 Jul 2.
Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real-world AMPs up to 2 years post discharge for ACS.
There is wide variability in AMP use for ACS management in Asia.
EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months.
Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow-up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non-randomized study.
Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.
尽管有指南建议，但急性冠状动脉综合征（ACS）事件后，双联抗血小板治疗（DAPT）的使用时间仍常超过 1 年。在亚洲，关于抗血栓治疗管理模式（AMPs）的信息，包括出院后的 DAPT，十分有限。本分析评估了 ACS 患者出院后长达 2 年的真实世界 AMPS。
亚洲 ACS 管理中的 AMP 使用存在广泛的变异性。
EPICOR Asia（NCT01361386）是一项在亚洲八个国家/地区进行的 ACS 住院患者出院后的前瞻性观察性研究，随访 2 年。在此，我们描述了使用的 AMP，并对出院后 12 个月内接受 DAPT 治疗的患者与 12 个月以上的患者的特征和结局进行了探索性分析。
共纳入 12922 例患者的数据；11639 例出院时接受 DAPT 的患者中，2364 例（20.3%）接受 DAPT 治疗≤12 个月，9275 例（79.7%）治疗>12 个月，约 60%的患者在 2 年后仍接受 DAPT。接受 DAPT 治疗>12 个月的患者更年轻、肥胖、较低的 Killip 分级、居住在印度（而非中国），并接受了侵入性再灌注。在随访的第 2 年，接受 DAPT 治疗>12 个月与≤12 个月的患者临床事件发生率较低，但在这项非随机研究中，不能暗示存在因果关系。
大多数 ACS 患者在符合当前指南的情况下，在 1 年内仍接受 DAPT 治疗，超过一半的患者在出院后 2 年内仍接受 DAPT 治疗。在 12 个月时未接受 DAPT 的患者为高危人群，需要仔细监测。
