Long-term antiplatelet therapy in medically managed non-ST-segment elevation acute coronary syndromes: The EPICOR
Juan Zhou1, Chee Tang Chin2, Xin Huang3
1First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, PR China.
Insights
Long-term dual antiplatelet therapy (DAPT) use was common in Asian patients with non-ST-segment myocardial infarction (NSTEMI) or unstable angina (UA). NSTEMI patients experienced more major adverse cardiovascular events (MACE) than UA patients.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Current guidelines recommend early invasive strategies for non-ST-segment myocardial infarction (NSTEMI) and unstable angina (UA).
- However, many patients receive medical management, with limited data on long-term antithrombotic management patterns (AMPs) in Asia.
Purpose of the Study:
- To describe long-term antithrombotic management patterns (AMPs).
- To evaluate major adverse cardiovascular events (MACE) and bleeding risks in medically managed Asian patients with NSTEMI or UA.
Main Methods:
- Analysis of data from the prospective, observational EPICOR Asia study (NCT01361386).
- Inclusion of medically managed NSTEMI and UA patients surviving to hospital discharge.
- Collection of baseline characteristics and AMP use up to 2 years post-discharge, with outcomes including MACE and bleeding.
Main Results:
- Dual antiplatelet therapy (DAPT) use at discharge was higher in NSTEMI (81.8%) than UA (65.3%) patients.
- At 2 years, DAPT use was 57.9% for NSTEMI and 42.6% for UA patients.
- Older age, NSTEMI diagnosis, and chronic renal failure were significantly associated with increased MACE risk; region and diabetes were linked to bleeding risk.
Conclusions:
- Approximately half of patients remained on DAPT at 2 years.
- NSTEMI patients experienced higher MACE rates compared to UA patients during follow-up.
Objectives:
To describe long-term antithrombotic management patterns (AMPs) in medically managed Asian patients with non-ST-segment myocardial infarction (NSTEMI) or unstable angina (UA).
Background:
Current guidelines support an early invasive strategy in NSTEMI and UA patients, but many are medically managed, and data are limited on long-term AMPs in Asia.
Methods:
Data were analyzed from medically managed NSTEMI and UA patients included in the prospective, observational EPICOR Asia study (NCT01361386). Survivors to hospital discharge were enrolled (June 2011 to May 2012) from 8 countries/regions across Asia. Baseline characteristics and AMP use up to 2 years post-discharge were collected. Outcomes were major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, and death) and bleeding.
Results:
Among 2289 medically managed patients, dual antiplatelet therapy (DAPT) use at discharge was greater in NSTEMI than in UA patients (81.8% vs 65.3%), and was significantly associated with male sex, positive cardiac markers, and prior cardiovascular medications (p < 0.0001). By 2 years, 57.9% and 42.6% of NSTEMI and UA patients, respectively, were on DAPT. On multivariable Cox regression analysis, risk of MACE at 2 years was most significantly associated with older age (HR [95% CI] 1.85 [1.36, 2.50]), diagnosis of NSTEMI vs UA (1.96 [1.47, 2.61]), and chronic renal failure (2.14 [1.34, 3.41]), all p ≤ 0.001. Risk of bleeding was most significantly associated with region (East Asia vs Southeast/South Asia) and diabetes.
Conclusions:
Approximately half of all patients were on DAPT at 2 years. MACE were more frequent in NSTEMI than UA patients during follow-up.
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