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Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria
BACKGROUND: We evaluated the effectiveness of extended dual antiplatelet therapy (DAPT) usage after 2nd-generation drug elution stent implantation in acute myocardial infarction (AMI) survivors with high ischemic risk characteristics who had no major bleeding for 24 months under at least 1 year of D...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712205/ https://www.ncbi.nlm.nih.gov/pubmed/36465433 http://dx.doi.org/10.3389/fcvm.2022.1017533 |
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author | Lee, Kwan Yong Hwang, Byung-Hee Choo, Eun-Ho Lim, Sungmin Kim, Chan Jun Kim, Jin-Jin Byeon, Jaeho Choi, Ik Jun Oh, Gyu Chul Choi, Yoon Seok Yoo, Ki Dong Chung, Wook Sung Ahn, Youngkeun Jeong, Myung Ho Chang, Kiyuk |
author_facet | Lee, Kwan Yong Hwang, Byung-Hee Choo, Eun-Ho Lim, Sungmin Kim, Chan Jun Kim, Jin-Jin Byeon, Jaeho Choi, Ik Jun Oh, Gyu Chul Choi, Yoon Seok Yoo, Ki Dong Chung, Wook Sung Ahn, Youngkeun Jeong, Myung Ho Chang, Kiyuk |
author_sort | Lee, Kwan Yong |
collection | PubMed |
description | BACKGROUND: We evaluated the effectiveness of extended dual antiplatelet therapy (DAPT) usage after 2nd-generation drug elution stent implantation in acute myocardial infarction (AMI) survivors with high ischemic risk characteristics who had no major bleeding for 24 months under at least 1 year of DAPT maintenance. MATERIALS AND METHODS: The primary ischemic and bleeding endpoints were the risk of mortality and the risk of BARC 3 or 5 (major) bleeding. We investigated the event rates for 2–5 years after the index procedure. RESULTS: Of 3382 post-AMI survivors who met the PEGASUS-TIMI 54 (PEGASUS) criteria and without major bleeding until 2 years, 2281 (67.4%) maintained DAPT over 24 months, and 1101 (32.5%) switched DAPT to a single antiplatelet agent. The >24 M DAPT group showed a lower risk of mortality than the 12–24 M DAPT group (7.2 vs. 9.2%; adjusted hazard ratio: 0.648; 95% confidence interval: 0.595–0.976; p < 0.001). The mortality risk was significantly greater as the number of PEGASUS criteria increased (p < 0.001). DAPT > 24 months was not significantly associated with a decreased risk for major bleeding in the population meeting the PEGASUS criteria (2.0 vs. 1.1%; p = 0.093). The results were consistent after propensity-score matching and inverse probability weighting to adjust for baseline differences. CONCLUSION: Extended DAPT over 24 months was associated with a lower risk of mortality without increasing the risk of major bleeding among 2 years survivors after AMI who met the PEGASUS criteria and had no major bleeding events before 24 months. |
format | Online Article Text |
id | pubmed-9712205 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97122052022-12-02 Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria Lee, Kwan Yong Hwang, Byung-Hee Choo, Eun-Ho Lim, Sungmin Kim, Chan Jun Kim, Jin-Jin Byeon, Jaeho Choi, Ik Jun Oh, Gyu Chul Choi, Yoon Seok Yoo, Ki Dong Chung, Wook Sung Ahn, Youngkeun Jeong, Myung Ho Chang, Kiyuk Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: We evaluated the effectiveness of extended dual antiplatelet therapy (DAPT) usage after 2nd-generation drug elution stent implantation in acute myocardial infarction (AMI) survivors with high ischemic risk characteristics who had no major bleeding for 24 months under at least 1 year of DAPT maintenance. MATERIALS AND METHODS: The primary ischemic and bleeding endpoints were the risk of mortality and the risk of BARC 3 or 5 (major) bleeding. We investigated the event rates for 2–5 years after the index procedure. RESULTS: Of 3382 post-AMI survivors who met the PEGASUS-TIMI 54 (PEGASUS) criteria and without major bleeding until 2 years, 2281 (67.4%) maintained DAPT over 24 months, and 1101 (32.5%) switched DAPT to a single antiplatelet agent. The >24 M DAPT group showed a lower risk of mortality than the 12–24 M DAPT group (7.2 vs. 9.2%; adjusted hazard ratio: 0.648; 95% confidence interval: 0.595–0.976; p < 0.001). The mortality risk was significantly greater as the number of PEGASUS criteria increased (p < 0.001). DAPT > 24 months was not significantly associated with a decreased risk for major bleeding in the population meeting the PEGASUS criteria (2.0 vs. 1.1%; p = 0.093). The results were consistent after propensity-score matching and inverse probability weighting to adjust for baseline differences. CONCLUSION: Extended DAPT over 24 months was associated with a lower risk of mortality without increasing the risk of major bleeding among 2 years survivors after AMI who met the PEGASUS criteria and had no major bleeding events before 24 months. Frontiers Media S.A. 2022-11-17 /pmc/articles/PMC9712205/ /pubmed/36465433 http://dx.doi.org/10.3389/fcvm.2022.1017533 Text en Copyright © 2022 Lee, Hwang, Choo, Lim, Kim, Kim, Byeon, Choi, Oh, Choi, Yoo, Chung, Ahn, Jeong and Chang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Lee, Kwan Yong Hwang, Byung-Hee Choo, Eun-Ho Lim, Sungmin Kim, Chan Jun Kim, Jin-Jin Byeon, Jaeho Choi, Ik Jun Oh, Gyu Chul Choi, Yoon Seok Yoo, Ki Dong Chung, Wook Sung Ahn, Youngkeun Jeong, Myung Ho Chang, Kiyuk Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria |
title | Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria |
title_full | Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria |
title_fullStr | Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria |
title_full_unstemmed | Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria |
title_short | Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria |
title_sort | clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the pegasus-timi 54 criteria |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712205/ https://www.ncbi.nlm.nih.gov/pubmed/36465433 http://dx.doi.org/10.3389/fcvm.2022.1017533 |
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