Bonanad Clara, Raposeiras-Roubin Sergio, García-Blas Sergio, Núñez-Gil Iván, Vergara-Uzcategui Carlos, Díez-Villanueva Pablo, Bañeras Jordi, Badía Molins Clara, Aboal Jaime, Carreras Jose, Bodi Vicente, Gabaldón-Pérez Ana, Mateus-Porta Gemma, Parada Barcia Jose Antonio, Martínez-Sellés Manuel, Chorro Francisco Javier, Ariza-Solé Albert
Cardiology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain.
Department of Cardiology, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
J Clin Med. 2022 Mar 17;11(6):1680. doi: 10.3390/jcm11061680.
Clinical practice guidelines recommend extending dual antiplatelet therapy (DAPT) beyond 1 year after acute coronary syndrome (ACS) in patients with high ischemic risk and without high bleeding risk. The aim of this study was to identify variables associated with DAPT prolongation in a cohort of 1967 consecutive patients discharged after ACS without thrombotic or hemorrhagic events during the following year. The sample was stratified according to whether DAPT was extended beyond 1 year, and the factors associated with this strategy were analyzed. In 32.2% of the patients, DAPT was extended beyond 1 year. Overall, 770 patients (39.1%) were considered candidates for extended treatment based on PEGASUS criteria and absence of high bleeding risk, and DAPT was extended in 34.4% of them. The presence of a PEGASUS criterion was associated with extended DAPT in the univariate analysis, but not history of bleeding or a high bleeding risk. In the multivariate analysis, a history of percutaneous coronary intervention (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.4-2.4), stent thrombosis (OR = 3.8, 95% CI 1.7-8.9), coronary artery disease complexity (OR = 1.3, 95% CI 1.1-1.5), reinfarction (OR = 4.1, 95% CI 1.6-10.4), and clopidogrel use (OR = 1.3, 95% CI 1.1-1.6) were significantly associated with extended use. DAPT was extended in 32.2% of patients who survived ACS without thrombotic or hemorrhagic events. This percentage was 34.4% when the candidates were analyzed according to clinical guidelines. Neither the PEGASUS criteria nor the bleeding risk was independently associated with this strategy.
临床实践指南建议，对于急性冠状动脉综合征（ACS）后缺血风险高且无高出血风险的患者，双联抗血小板治疗（DAPT）应延长至1年以上。本研究的目的是在1967例ACS后出院且在接下来一年中无血栓形成或出血事件的连续患者队列中，确定与DAPT延长相关的变量。根据DAPT是否延长至1年以上对样本进行分层，并分析与该策略相关的因素。在32.2%的患者中，DAPT延长至1年以上。总体而言，770例患者（39.1%）根据PEGASUS标准且无高出血风险被认为是延长治疗的候选者，其中34.4%的患者接受了DAPT延长治疗。在单因素分析中，PEGASUS标准的存在与DAPT延长相关，但出血史或高出血风险与DAPT延长无关。在多因素分析中，经皮冠状动脉介入治疗史（比值比（OR）=1.8，95%置信区间（CI）1.4-2.4）、支架血栓形成（OR = 3.8，95%CI 1.7-8.9）、冠状动脉疾病复杂性（OR = 1.3，95%CI 1.1-1.5）、再梗死（OR = 4.1，95%CI 1.6-10.4）和使用氯吡格雷（OR = 1.3，95%CI 1.1-1.6）与延长使用显著相关。在无血栓形成或出血事件的ACS存活患者中，32.2%的患者接受了DAPT延长治疗。根据临床指南分析候选者时，这一比例为34.4%。PEGASUS标准和出血风险均与该策略无独立相关性。
