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Prolonged dual antiplatelet therapy in patients with non-ST-segment elevation myocardial infarction: 2-year findings from EPICOR Asia.
Clin Cardiol. 2020 Apr; 43(4):346-354.CC

Abstract

BACKGROUND

Patients with non-ST-segment elevation myocardial infarction (NSTEMI) have a generally poor prognosis and antithrombotic management patterns (AMPs) used post-acute coronary syndrome (ACS) remain unclear. Duration of dual antiplatelet therapy (DAPT) and patient characteristics was evaluated in NSTEMI patients enrolled in EPICOR Asia.

HYPOTHESIS

Patients stopping DAPT early may benefit from more intensive monitoring.

METHODS

EPICOR Asia was a prospective, real-world, primary data collection, cohort study in adults with an ACS, conducted in eight countries/regions in Asia, with 2 year follow-up. Eligible patients were hospitalized within 48 hours of symptom onset and survived to discharge. We describe AMPs and baseline characteristics in NSTEMI patients surviving ≥12 months with DAPT duration ≤12 and > 12 months post-discharge. Clinical outcomes (composite of death, myocardial infarction, and stroke; and bleeding) were also explored.

RESULTS

At discharge, 90.8% of patients were on DAPT (including clopidogrel, 99%). At 1- and 2-year follow-up, this was 79.2% and 60.0%. Patients who stopped DAPT ≤12 months post-discharge tended to be older, female, less obese, have prior cardiovascular disease, and have renal dysfunction. While causality cannot be inferred, the incidence of the composite endpoint over the subsequent 12 months was 10.6% and 3.1% with shorter vs longer use of DAPT, and mortality risk over the same period was 8.4% and 1.6%.

CONCLUSIONS

Over 90% of NSTEMI patients were discharged on DAPT, with 60% on DAPT at 2 years. Patients stopping DAPT early were more likely to have higher baseline risk and may therefore benefit from more intensive monitoring during long-term follow-up.

Authors+Show Affiliations

Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China.Department of Cardiology, National Heart Centre Singapore, Singapore.Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.Peking University First Hospital, Beijing, China.Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31967663

Citation

Zou, Yanan, et al. "Prolonged Dual Antiplatelet Therapy in Patients With non-ST-segment Elevation Myocardial Infarction: 2-year Findings From EPICOR Asia." Clinical Cardiology, vol. 43, no. 4, 2020, pp. 346-354.
Zou Y, Yang S, Wang S, et al. Prolonged dual antiplatelet therapy in patients with non-ST-segment elevation myocardial infarction: 2-year findings from EPICOR Asia. Clin Cardiol. 2020;43(4):346-354.
Zou, Y., Yang, S., Wang, S., Lv, B., Xiu, L., Li, L., Lee, S. W., Chin, C. T., Pocock, S. J., Huo, Y., & Yu, B. (2020). Prolonged dual antiplatelet therapy in patients with non-ST-segment elevation myocardial infarction: 2-year findings from EPICOR Asia. Clinical Cardiology, 43(4), 346-354. https://doi.org/10.1002/clc.23322
Zou Y, et al. Prolonged Dual Antiplatelet Therapy in Patients With non-ST-segment Elevation Myocardial Infarction: 2-year Findings From EPICOR Asia. Clin Cardiol. 2020;43(4):346-354. PubMed PMID: 31967663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prolonged dual antiplatelet therapy in patients with non-ST-segment elevation myocardial infarction: 2-year findings from EPICOR Asia. AU - Zou,Yanan, AU - Yang,Shuang, AU - Wang,Shipeng, AU - Lv,Bo, AU - Xiu,Lili, AU - Li,Lulu, AU - Lee,Stephen W-L, AU - Chin,Chee Tang, AU - Pocock,Stuart J, AU - Huo,Yong, AU - Yu,Bo, Y1 - 2020/01/22/ PY - 2019/11/06/received PY - 2019/11/29/revised PY - 2019/12/01/accepted PY - 2020/1/23/pubmed PY - 2020/1/23/medline PY - 2020/1/23/entrez KW - EPICOR Asia KW - NSTEMI KW - acute coronary syndrome KW - antithrombotic management pattern KW - dual antiplatelet therapy SP - 346 EP - 354 JF - Clinical cardiology JO - Clin Cardiol VL - 43 IS - 4 N2 - BACKGROUND: Patients with non-ST-segment elevation myocardial infarction (NSTEMI) have a generally poor prognosis and antithrombotic management patterns (AMPs) used post-acute coronary syndrome (ACS) remain unclear. Duration of dual antiplatelet therapy (DAPT) and patient characteristics was evaluated in NSTEMI patients enrolled in EPICOR Asia. HYPOTHESIS: Patients stopping DAPT early may benefit from more intensive monitoring. METHODS: EPICOR Asia was a prospective, real-world, primary data collection, cohort study in adults with an ACS, conducted in eight countries/regions in Asia, with 2 year follow-up. Eligible patients were hospitalized within 48 hours of symptom onset and survived to discharge. We describe AMPs and baseline characteristics in NSTEMI patients surviving ≥12 months with DAPT duration ≤12 and > 12 months post-discharge. Clinical outcomes (composite of death, myocardial infarction, and stroke; and bleeding) were also explored. RESULTS: At discharge, 90.8% of patients were on DAPT (including clopidogrel, 99%). At 1- and 2-year follow-up, this was 79.2% and 60.0%. Patients who stopped DAPT ≤12 months post-discharge tended to be older, female, less obese, have prior cardiovascular disease, and have renal dysfunction. While causality cannot be inferred, the incidence of the composite endpoint over the subsequent 12 months was 10.6% and 3.1% with shorter vs longer use of DAPT, and mortality risk over the same period was 8.4% and 1.6%. CONCLUSIONS: Over 90% of NSTEMI patients were discharged on DAPT, with 60% on DAPT at 2 years. Patients stopping DAPT early were more likely to have higher baseline risk and may therefore benefit from more intensive monitoring during long-term follow-up. SN - 1932-8737 UR - https://www.unboundmedicine.com/medline/citation/31967663/Prolonged_dual_antiplatelet_therapy_in_patients_with_non_ST_segment_elevation_myocardial_infarction:_2_year_findings_from_EPICOR_Asia_ L2 - https://doi.org/10.1002/clc.23322 DB - PRIME DP - Unbound Medicine ER -
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