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Impact of Chronic Antiplatelet Therapy on Clinical Outcomes of First-Time ST-Elevation Myocardial Infarction

Aryan Malhotra1, Mariam Ahmed1, James M Beck1

  • 1From the Department of Medicine, New York Medical College School of Medicine, Valhalla, NY.

Cardiology in Review
|May 19, 2026
PubMed

Insights

Patients on chronic antiplatelet therapy (cAPT) with first-time ST-elevation myocardial infarction (STEMI) had better outcomes. This analysis of over one million STEMI hospitalizations found cAPT was linked to lower mortality and fewer complications.

Area of Science:

  • Cardiology
  • Clinical Research
  • Public Health

Background:

  • ST-elevation myocardial infarction (STEMI) is a major cause of death and disability.
  • Understanding treatment impacts on STEMI outcomes is crucial for patient care.
  • Chronic antiplatelet therapy (cAPT) use in first-time STEMI patients requires further investigation.

Purpose of the Study:

  • To evaluate the association between chronic antiplatelet therapy (cAPT) and inpatient outcomes in patients hospitalized with their first ST-elevation myocardial infarction (STEMI).
  • To analyze treatment modalities, complications, and mortality in STEMI patients on cAPT versus those not on cAPT.

Main Methods:

  • Retrospective cross-sectional study using the National Inpatient Sample database (2015-2022).
  • Inclusion of patients ≥18 years old hospitalized with a first STEMI.
  • Propensity score-based inverse probability of treatment weighting (IPTW) and multivariable logistic regression to adjust for confounding factors.

Main Results:

  • Among 1,070,085 first-time STEMI hospitalizations, 236,085 (22.1%) involved patients on cAPT.
  • Patients on cAPT showed higher odds of receiving coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).
  • cAPT was associated with reduced bleeding, mural thrombus, acute heart failure, lower inpatient mortality, and higher routine discharge rates after IPTW.

Conclusions:

  • Chronic antiplatelet therapy (cAPT) is associated with significantly improved inpatient outcomes in first-time ST-elevation myocardial infarction (STEMI) hospitalizations.
  • cAPT use in this population did not increase the risk of overall complications.
  • Findings suggest a potential benefit of cAPT in managing STEMI patients, warranting further prospective research.

Keywords:
STEMIacute myocardial infarctionantiplatelet therapymortalitypercutaneous coronary interventiontherapeutic strategies for STEMI management

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