Impact of prolonged dual antiplatelet therapy after acute myocardial infarction on 5-year mortality in the FAST-MI 2005 registry.

Abstract

BACKGROUND:

We document dual antiplatelet therapy (DAPT) use from discharge to 4 years after acute myocardial infarction (AMI), and investigate whether prolonged DAPT (beyond 1 year) is related to 5-year mortality.

METHODS:

The French Registry of Acute ST-elevation or non-ST-elevation Myocardial Infarction (FAST-MI 2005) included 3670 patients with AMI in 223 French centres. We identified predictors of DAPT (aspirin+clopidogrel) beyond 1 and 2 years, and relation with all-cause 5-year mortality.

RESULTS:

Among 3319 (96%) patients with discharge data, 2432 (73%) had DAPT, 582 (17%) single antiplatelet therapy (SAPT), and 305 (9%) no antiplatelet treatment. DAPT decreased from 75% at 1 year to 29% at 4 years, with a corresponding increase in SAPT (p<0.05 for trend). Patients with DAPT were more often male, treated with a drug-eluting stent (DES), and without oral anticoagulants. Independent predictors at 1 year of prolonged DAPT were age<75 years, in-hospital bleeding, history of MI, use of DES, discharge use of beta-blockers or statins and no chronic anticoagulation. Predictors at 2 years were age<75 years, male gender, previous MI, diabetes, DES implantation, no chronic oral anticoagulation. By multivariate analysis, there was no difference in 5-year mortality between those on SAPT vs DAPT at 1 year. DAPT at 2 years was also not significantly related to 5-year mortality (Hazard Ratio 1.3, 95% CI [0.9; 1.8], p=0.21).

CONCLUSION:

Prolonged DAPT in selected AMI patients, observed in 47% at 1 year and 21% at 2 years, had no impact on 5-year mortality. These findings do not support the use of DAPT beyond 1 year after an initial ACS.

• Authors: Francois Schiele, Etienne Puymirat, Laurent Bonello, Gilles Dentan, Nicolas Meneveau, Jean-Philippe Collet, Pascal Motreff, Ramin Ravan, Florence Leclercq, Pierre-Vladimir Ennezat, Jean Ferrières, Laurence Berard, Tabassome Simon, Nicolas Danchin
• Journal: International journal of cardiology (Int J Cardiol) Vol. 187 Pg. 354-60 ( 2015) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 25839641 (Publication Type: Clinical Study, Journal Article)
• Copyright: Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Aged
• Aspirin (administration & dosage)
• Clopidogrel
• Drug-Eluting Stents
• Female
• Humans
• Male
• Myocardial Infarction (drug therapy, mortality)
• Platelet Aggregation Inhibitors (administration & dosage)
• Prospective Studies
• Registries
• Ticlopidine (administration & dosage, analogs & derivatives)
• Time Factors