In managing this condition, dual antiplatelet therapy (DAPT) becomes a cornerstone, especially after percutaneous coronary intervention (PCI). But what is the optimal duration for DAPT, particularly in an Asian cohort? A study published in the “Circulation Journal,” the official journal of the Japanese Circulation Society, sheds light on this query, zeroing in on real-world observations from Taiwan between 2012 and 2015.
In the research article titled “Duration of Clopidogrel-Based Dual Antiplatelet Therapy and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention – A Real-World Observation in Taiwan,” scientists assessed outcomes linked to the length of clopidogrel-based DAPT in ACS patients. The study, led by Li Yi-Heng YH and colleagues, indicated that a longer duration of DAPT beyond nine months could be associated with better clinical outcomes.
DOI: 10.1253/circj.CJ-18-1283
The study involved 2,221 ACS patients, with an average age of 62, most of whom were men (83%). Patients received clopidogrel-based DAPT after undergoing PCI, and the primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke.
Researchers observed that 42.1% of patients had DAPT durations of nine months or less. The incidence of the primary outcome was significantly higher in this group compared to those who continued DAPT for more than nine months: 3.5% versus 1.6% at one year (P=0.0026).
Interestingly, stent thrombosis incidents, which occurred in 0.5% of cases, did not differ significantly between the two groups. Nonetheless, after adjusting for multiple variables, the data suggested that a DAPT duration exceeding nine months had a significantly lower risk of the primary composite outcome, with an odds ratio of 0.725 and a 95% confidence interval of 0.545-0.965.
This study is pivotal in understanding the real-world implications of DAPT duration in a Taiwanese context and potentially in broader Asian settings, where there is scarce data. It concludes that a considerable portion of ACS patients in Taiwan underwent DAPT for nine months or less, a duration that seemed to increase the risk of adverse cardiovascular events within a year following PCI.
References
1. Li, Y.-H., Chiu, Y.-W., Cheng, J.-J., Hsieh, I.-C., Lo, P.-H., Lei, M.-H., Ueng, K.-C., Chiang, F.-T., Sung, S.-H., Kuo, J.-Y., Chen, C.-P., Lai, W.-T., Lee, W.-L., Chen, J.-H., & Taiwan ACS STENT Registry Investigators. (2020). Duration of Clopidogrel-Based Dual Antiplatelet Therapy and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Circulation Journal, 83(6), 1317-1323. doi:10.1253/circj.CJ-18-1283
2. Levine, G. N., Bates, E. R., Bittl, J. A., Brindis, R. G., Fihn, S. D., Fleisher, L. A., … & Williams, S. V. (2016). 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. Journal of the American College of Cardiology, 68(10), 1082-1115.
3. Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., … & Zhao, Y. (2014). 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Circulation, 130(25), e344-e426.
4. Valgimigli, M., Bueno, H., Byrne, R. A., Collet, J. P., Costa, F., Jeppsson, A., … & ESC Scientific Document Group. (2018). 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. European Heart Journal, 39(3), 213-260.
5. Wiviott, S. D., Braunwald, E., McCabe, C. H., Montalescot, G., Ruzyllo, W., Gottlieb, S., … & Antman, E. M. (2007). Prasugrel versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 357(20), 2001-2015.
Keywords
1. Dual Antiplatelet Therapy
2. Acute Coronary Syndrome
3. Percutaneous Coronary Intervention
4. Clopidogrel
5. Cardiovascular Outcomes
Given the significant findings, this study holds not only clinical importance but also potential implications for healthcare policies within Asia, as it prompts a reassessment of the current DAPT guidelines to potentially extend the therapy duration to improve patient outcomes after PCI.