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Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients With Anterior ST-Segment Elevation
Laurie-Anne Boivin-Proulx, Simon-Pierre Demers, Fabrice Ieroncig
1Montreal Heart Institute, 5000 Belanger, Montreal, QC, Canada, H1T 1C8. guillaume.marquis.gravel@umontreal.ca.
Insights
Triple therapy (TT) with dual-antiplatelet therapy (DAPT) plus oral anticoagulant (OAC) did not significantly reduce net adverse clinical events (NACE) compared to DAPT alone in STEMI patients with wall-motion abnormalities. Both treatments showed similar ischemic and bleeding event risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Patients with ST-segment elevation myocardial infarction (STEMI) and new-onset anterior/apical wall-motion abnormalities (WMAs) may benefit from oral anticoagulants (OAC) to prevent left ventricular thrombus and cardioembolic events.
- Assessing the comparative effectiveness and safety of dual-antiplatelet therapy (DAPT) versus triple therapy (TT) (DAPT + OAC) is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the effectiveness and safety of DAPT versus TT in patients with anterior STEMI and new-onset anterior/apical WMAs undergoing primary percutaneous coronary intervention (PCI).
- To evaluate the composite endpoint of net adverse clinical events (NACE) at 6 months, including mortality, myocardial infarction, stroke, and major bleeding.
Main Methods:
- A multicenter, retrospective cohort study included 1666 patients with anterior STEMI and WMAs treated with primary PCI.
- Patients were divided into two groups: those discharged on TT (n=627) and those on DAPT (n=1039), excluding those with a concomitant indication for OAC.
- Adjusted Cox proportional hazards analysis and inverse probability of treatment weighting were used to compare outcomes.
Main Results:
- The incidence of NACE at 6 months was 6.03 per 100 patient-years in the TT group and 7.18 per 100 patient-years in the DAPT group (adjusted hazard ratio, 0.86; 95% CI, 0.55-1.32).
- There were no significant differences in the adjusted risks of individual components of the primary endpoint, including ischemic events and major bleeding (BARC type 3 or 5), between the TT and DAPT groups (P>.05 for all).
Conclusions:
- The addition of OAC to DAPT in anterior STEMI patients with new-onset WMAs treated with PCI was not associated with a significant reduction in NACE.
- Treatment strategies involving TT or DAPT alone demonstrated similar safety and efficacy profiles regarding major adverse clinical and bleeding events in this specific patient cohort.
Objectives:
The objective is to assess the comparative effectiveness and safety of dual-antiplatelet therapy (DAPT) vs triple therapy (TT) with DAPT + oral anticoagulant (OAC) in patients with anterior ST-segment elevation myocardial infarction (STEMI) and with new-onset anterior/apical wall-motion abnormalities (WMAs) treated with primary percutaneous coronary intervention (PCI).
Background:
Patients with STEMI and new-onset anterior/apical WMA may benefit from the addition of OAC to prevent left ventricular thrombus and cardioembolic events.
Methods:
A multicenter, retrospective cohort study was conducted. Patients with a concomitant indication for OAC were excluded. Patients discharged on TT were compared with patients discharged on DAPT using adjusted Cox proportional hazards analysis and inverse probability of treatment weighting. The primary endpoint was the net adverse clinical event (NACE) rate at 6 months (composite of all-cause mortality, non-fatal MI, stroke, or transient ischemic attack, systemic thromboembolism or type 3 or 5 Bleeding Academic Research Consortium [BARC] bleeding).
Results:
A total of 1666 patients were included, among which 627 were treated with TT and 1039 were treated with DAPT. A NACE occurred in 55 patients (6.03 per 100 patient-years) in the TT group and in 74 patients (7.18 per 100 patient-years) in the DAPT group (adjusted hazard ratio, 0.86; 95% confidence interval, 0.55-1.32). Adjusted risk of the individual components of the primary endpoint, ischemic events, and bleeding events were similar between both groups (P>.05 for all).
Conclusions:
The addition of OAC to DAPT in anterior STEMI patients with new-onset WMA treated with PCI was not associated with a significant reduction in NACE.
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