Arbel Yaron, Patel Ashish D, Goodman Shaun G, Tan Mary K, Suskin Neville, McKelvie Robert S, Mathew Andrew L, Ahmed Firas, Lutchmedial Sohrab, Dehghani Payam, Lavoie Andrea J, Huynh Thao, Lavi Shahar, Khan Razi, Yan Andrew T, Fordyce Christopher B, Heffernan Michael, Jedrzkiewicz Sean, Madan Mina, Ahmed Shaheeda, Barry Colin, Dery Jean-Pierre, Bagai Akshay
Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2021 Jul 23;3(12):1463-1470. doi: 10.1016/j.cjco.2021.07.013. eCollection 2021 Dec.
Extension of dual antiplatelet therapy (DAPT) beyond 1 year after acute coronary syndrome is associated with a reduction in ischemic events but also increased bleeding. The DAPT score identifies individuals likely to derive overall benefit or harm from DAPT extension. We sought to evaluate the impact of providing the DAPT score to treating physicians on the decision to extend DAPT beyond 1 year after non-ST-segment elevation myocardial infarction.
Moderate to high-risk non-ST-segment elevation myocardial infarction patients were enrolled from July 2016 to May 2018 in 13 Canadian hospitals by 52 cardiologists. Participating cardiologists were randomly assigned 1:1 to receive their individual patients' DAPT scores before the 1-year follow-up visit vs not receiving their patients' DAPT scores. Rates of DAPT extension were compared among the randomized groups.
At 1 year, 370 of the 585 (63.2%) patients discharged on DAPT were receiving DAPT. Among patients on DAPT at 1 year, the median (25th, 75th percentile) DAPT score was 2 (1,3). DAPT was extended beyond 1 year in 36.2% randomly assigned to provision of DAPT score vs 35.7% in the control group ( = 0.93). In the subgroup of patients with DAPT score ≥ 2, DAPT extension was 49.5% in the DAPT score provision arm vs 40.4% in the control arm ( = 0.22); among patients with DAPT score < 2, DAPT termination was 78.6% in the DAPT score provision arm vs 70.6% in the control arm ( = 0.26) ( value for interaction = 0.1).
In this exploratory randomized trial, provision of the DAPT score to treating physicians had no impact on the duration of DAPT treatment beyond 1 year.
急性冠状动脉综合征后双联抗血小板治疗（DAPT）延长至1年以上与缺血事件减少相关，但出血风险也会增加。DAPT评分可识别出可能从DAPT延长治疗中获得总体益处或受到伤害的个体。我们旨在评估向治疗医生提供DAPT评分对非ST段抬高型心肌梗死后DAPT延长至1年以上决策的影响。
2016年7月至2018年5月，52位心脏病专家在加拿大13家医院招募了中高危非ST段抬高型心肌梗死患者。参与研究的心脏病专家被随机1:1分配，一组在1年随访就诊前接收其个体患者的DAPT评分，另一组不接收其患者的DAPT评分。比较随机分组组间DAPT延长的发生率。
1年时，585例出院时接受DAPT治疗的患者中有370例（63.2%）仍在接受DAPT治疗。在1年时接受DAPT治疗的患者中，DAPT评分的中位数（第25、75百分位数）为2（1,3）。随机分配到提供DAPT评分组的患者中，36.2%的患者DAPT延长至1年以上，而对照组为35.7%（P = 0.93）。在DAPT评分≥2的患者亚组中，提供DAPT评分组的DAPT延长率为49.5%，而对照组为40.4%（P = 0.22）；在DAPT评分<2的患者中，提供DAPT评分组的DAPT终止率为78.6%，而对照组为70.6%（P = 0.26）（交互作用P值 = 0.1）。
在这项探索性随机试验中，向治疗医生提供DAPT评分对DAPT治疗超过1年的疗程没有影响。
