Li Yi-Heng, Hsieh I-Chang, Lin Hui-Wen, Lin Sheng-Hsiang
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan.
Acta Cardiol Sin. 2025 Jan;41(1):106-120. doi: 10.6515/ACS.202501_41(1).20240916B.
Dual antiplatelet therapy (DAPT) is the standard treatment for acute myocardial infarction (MI). This study aimed to investigate the use of DAPT and de-escalation after discharge in real-world practice among patients with acute MI undergoing percutaneous coronary intervention (PCI) in Taiwan.
Using the Taiwan National Health Insurance Research Database, we included patients who received PCI for acute MI and survived to discharge with DAPT from 2011 to 2021. The choice of different P2Y12 inhibitors at discharge and de-escalation therapy after discharge were analyzed.
Overall, 58989 patients (mean age 61.9 ± 13.2 years, male 81.4%) were included. The initial use of aspirin plus ticagrelor (A + T) increased from 4.8% in 2013 to 73.2% in 2021 (p < 0.01). Switch to de-escalation therapy occurred in 52.7% of the A + T users at 9 months follow-up. Aspirin plus clopidogrel (A + C) and ticagrelor monotherapy were the most commonly used de-escalation therapies in the first 6 months. Multivariable logistic regression analysis demonstrated that older patients and those with non-ST-segment elevation MI, multi-vessel PCI, baseline bleeding risk and bleeding events during follow-up were more likely to receive ticagrelor monotherapy than A + C.
A + T has become the major initial DAPT for patients with acute MI undergoing PCI in Taiwan, but de-escalation is not uncommon after discharge. Ticagrelor monotherapy was more likely to be prescribed than A + C in those with multi-vessel PCI or bleeding concern.
双联抗血小板治疗（DAPT）是急性心肌梗死（MI）的标准治疗方法。本研究旨在调查台湾接受经皮冠状动脉介入治疗（PCI）的急性MI患者在现实世界中出院后DAPT的使用情况及降阶梯治疗情况。
利用台湾全民健康保险研究数据库，我们纳入了2011年至2021年因急性MI接受PCI并存活至出院且接受DAPT治疗的患者。分析了出院时不同P2Y12抑制剂的选择以及出院后的降阶梯治疗情况。
共纳入58989例患者（平均年龄61.9±13.2岁，男性占81.4%）。阿司匹林加替格瑞洛（A+T）的初始使用率从2013年的4.8%增至2021年的73.2%（p<0.01）。在9个月随访时，52.7%的A+T使用者转为降阶梯治疗。阿司匹林加氯吡格雷（A+C）和替格瑞洛单药治疗是前6个月最常用的降阶梯治疗方法。多变量逻辑回归分析表明，老年患者以及非ST段抬高型MI、多支血管PCI、基线出血风险和随访期间有出血事件的患者比A+C更有可能接受替格瑞洛单药治疗。
在台湾，A+T已成为接受PCI的急性MI患者主要的初始DAPT，但出院后降阶梯治疗并不少见。对于多支血管PCI或有出血顾虑的患者，替格瑞洛单药治疗比A+C更有可能被处方。
