Impact of extended dual antiplatelet therapy on long-term prognosis in patients with acute coronary syndrome complicated with anemia: A sub-analysis of the real-world OPT-CAD study.

Abstract

OBJECTIVES:

To evaluate the impact of extended dual antiplatelet therapy (DAPT) beyond 12 months on long-term prognosis in acute coronary syndrome (ACS) patients complicated with anemia undergoing percutaneous coronary intervention (PCI).

BACKGROUND:

Anemia is frequent among ACS patients and is associated with increased risk of adverse clinical outcomes.

METHODS:

A total of 6,953 patients were enrolled from the Optimal anti Platelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. A landmark analysis comparing extended DAPT versus single antiplatelet therapy (SAPT) at 12-24 months were performed in anemia patients without premature discontinuation of DAPT before 9 months and major clinical adverse events within 12 months. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, myocardial infarction, and stroke.

RESULTS:

Patients with anemia (n = 1,728) had higher rates of MACCE, all-cause mortality, and BARC type 2, 3, 5 bleeding (p < .05) compared to those without anemia (n = 5,225). Anemia patients received extended DAPT (n = 1,010) were associated with a lower risk of stroke (0.3% vs. 1.8%; HR, 0.14; 95% CI, 0.03-0.71; p = .018) compared to those received SAPT (n = 342). The rates of MACCE and all revascularization were lower in patients with extended DAPT, but the differences were not statistically significant. Risk of all-cause mortality and bleeding were comparable between the two groups.

CONCLUSIONS:

Extended DAPT beyond 12 months may reduce the incidence of stroke without increasing the risk of bleeding in anemic ACS patients who tolerate 12-month DAPT.

• Authors: Yu Zhao, Jing Li, Sicong Ma, Zaixin Jiang, Zhiguo Li, Xiaozeng Wang, Yaling Han, Yi Li
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 98 Issue 2 Pg. E235-E242 (08 01 2021) ISSN: 1522-726X [Electronic] United States
• PMID: 33817946 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 Wiley Periodicals LLC.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Acute Coronary Syndrome (diagnosis, drug therapy)
• Anemia (diagnosis)
• Drug Therapy, Combination
• Humans
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (adverse effects)
• Prognosis
• Treatment Outcome