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Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients

Helena Tizón-Marcos1, Andrea Toloba2, Isaac Subirana Cachinero3

  • 1Institut Hospital del Mar d'Investigacions Mediques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital del Mar, Barcelona, Spain.

Revista Espanola De Cardiologia (English Ed.)
|December 20, 2022
PubMed

Insights

Extending dual antiplatelet therapy (DAPT) for ST-segment elevation myocardial infarction (STEMI) survivors to 5 years did not improve long-term outcomes. High-risk patients on extended DAPT showed worse mortality and readmission rates compared to those on single therapy.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) is standard after ST-segment elevation myocardial infarction (STEMI).
  • Optimal DAPT duration post-STEMI is debated, particularly for high-risk patients.
  • Long-term effects of extended DAPT (up to 5 years) are not fully understood.

Purpose of the Study:

  • To evaluate the impact of extended DAPT on 5-year mortality and cardiovascular outcomes in STEMI survivors.
  • To investigate whether prolonged DAPT in high-risk STEMI patients improves long-term prognosis.
  • To analyze the association between DAPT duration and all-cause mortality, cardiovascular mortality, and cardiovascular readmission.

Main Methods:

  • Analysis of a cohort of 3107 STEMI patients, focusing on 1-year survivors.
  • Comparison of outcomes between patients on single antiplatelet therapy versus extended DAPT at 5 years.
  • Utilized propensity score matching and inverse probability weighting for robust analysis.

Main Results:

  • Extended DAPT (5 years) was associated with significantly higher 5-year cardiovascular mortality (3.6% vs 1.4%) and noncardiovascular mortality (5.8% vs 3.3%).
  • Patients on extended DAPT had substantially increased cardiovascular readmission or mortality (46.5% vs 11.4%).
  • Extended DAPT independently predicted worse all-cause mortality (HR 2.16), cardiovascular mortality (HR 2.83), and composite outcomes (HR 5.20).

Conclusions:

  • Extending DAPT to 5 years in high-risk STEMI survivors does not appear to improve long-term prognosis.
  • Prolonged DAPT may be associated with increased risks of mortality and cardiovascular events.
  • Findings suggest a re-evaluation of extended DAPT strategies in specific STEMI patient populations.
Abstract

Keywords:
Cohorte retrospectivaDoble terapia antiagregante plaquetariaDual antiplatelet therapyInfarto de miocardio con elevación del STRetrospective cohortST-elevation myocardial infarction

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