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Association of Mortality with Antiplatelet Treatment in Patients with Stent Placement or Angioplasty: A
Ho Geol Woo1,2, Hye Ah Lee3, Dong Ryeol Ryu4
1Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Insights
Adherence to antiplatelet monotherapy after stent placement or angioplasty significantly reduces cerebro-cardiovascular disease mortality. Antiplatelet monotherapy, compared with dual antiplatelet therapy (DAPT), shows a beneficial effect on mortality in these patients.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Research
Background:
- Antiplatelet drugs are crucial for patients with cardiovascular disease undergoing stent placement or angioplasty.
- Understanding the impact of different antiplatelet regimens on mortality is essential for optimizing patient care.
- Variations in adherence, agent number, and regimen type may influence outcomes.
Purpose of the Study:
- To investigate the association between adherence to antiplatelet therapy and mortality risk.
- To compare mortality risks associated with different numbers and types of antiplatelet agents.
- To evaluate the impact of antiplatelet regimens on mortality in patients undergoing stent placement or angioplasty.
Main Methods:
- A nested case-control study design was employed using data from 5415 eligible subjects.
- Data were collected from the National Health Insurance Service-National Sample Cohort in Korea (2002-2013).
- All-cause mortality, including cardiovascular disease, cerebrovascular disease, and cancer, was defined using the ICD-10.
Main Results:
- Adherence to antiplatelet monotherapy significantly decreased cerebro-cardiovascular disease mortality compared to discontinuation (OR 0.62).
- Aspirin and clopidogrel monotherapy showed significant reductions in cerebro-cardiovascular disease death versus dual antiplatelet therapy (DAPT) (OR 0.65 and 0.58, respectively).
- No significant difference in mortality was observed between aspirin and clopidogrel monotherapy.
Conclusions:
- Adherence to antiplatelet therapy, particularly monotherapy, may offer a survival benefit in patients with stent placement or angioplasty.
- Antiplatelet monotherapy appears to be associated with reduced mortality from cerebro-cardiovascular disease compared to DAPT.
- These findings suggest a potential benefit of antiplatelet monotherapy in managing mortality risk in this patient population.
Purpose:
Antiplatelet drugs are essential in patients with cardiovascular disease who undergo stent placement. We hypothesized that risks of mortality would differ according to adherence to antiplatelet agents, number of antiplatelet agents, and antiplatelet regimens in patients undergoing stent placement or angioplasty.
Materials And Methods:
Between 2002 and 2013, we initially enrolled 8671 subjects who underwent stent placement or angioplasty in the National Health Insurance Service-National Sample Cohort in Korea. Using the International Classification of Diseases, 10th revision, the incidence of all-cause death, including cardiovascular disease, cerebrovascular disease, and cancer, was defined. Using a nested case-control study design, controls were matched to cases at a ratio of 4:1, and a total of 5415 subjects were eligible for this study.
Results:
During a median follow-up period of 3.51 years, the incidence rate of all-cause death was 40 per 1000 person-years. We found that adherence to antiplatelet monotherapy significantly decreased risk of death by cerebro-cardiovascular disease, compared with discontinuation of antiplatelets [adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) (0.41-0.96)]. Compared with dual antiplatelet therapy (DAPT), aspirin and clopidogrel monotherapy significantly reduced death by cerebro-cardiovascular disease [adjusted OR 0.65, 95% CI (0.44-0.95) and adjusted OR 0.58, 95% CI (0.35-0.96), respectively]. There was no significant difference of mortality between aspirin monotherapy and clopidogrel monotherapy.
Conclusion:
Our study demonstrated that adherence to antiplatelet therapy and antiplatelet monotherapy, compared with DAPT, in patients with stent placement or angioplasty may have a beneficial effect on mortality in cerebro-cardiovascular disease.
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