Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline

Wang, Haoyu; Dou, Kefei; Wang, Yang; Yin, Dong; Xu, Bo; Gao, Runlin

doi:10.1007/s10557-020-07030-9

Cited by 10 publications

(12 citation statements)

References 45 publications

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“…It is necessary to continue antiplatelet therapy after PCI surgery, so as to improve the prognosis of patients. Studies have shown that there is a significant negative correlation between medication compliance and recurrence rate and mortality rate of patients with heart disease [ 18 ]. After discharge of AMI patients after PCI, due to various factors, postoperative health behavior execution is poor and medication compliance is low, which seriously affects postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Quality of Life, Psychological Status, Medication Compliance, and Prognosis of Patients with Acute Myocardial Infarction after PCI by Applying PDCA Cycle Management Model

Hong

Liu

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To discuss the changes in the quality of life, psychological status, medication compliance, and prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) by applying plan-do-check-action (PDCA) cycle management model. Methods. A total of 125 patients with AMI who underwent PCI in our hospital from June 2018 to June 2020 were selected and divided into control group (n = 62) and research group (n = 63) by the random number method. The conventional nursing measures were used in the control group, and the PDCA cycle management model on the basis of the control group was used in the research group. The changes in the quality of life, psychological status, medication compliance, and prognosis were observed. Results. After intervention, the Generic Quality of Life Inventory-74 scores and the self-made medication compliance questionnaire score of the research group were higher than the control group ( P < 0.05 ). After intervention, the self-rating anxiety scale score and self-rating depression scale score of the research group were lower than those of the control group ( P < 0.05 ). The total incidence of adverse events in the research group (7.94%) was lower than that in the control group (20.97%) ( P < 0.05 ). Conclusion. After the application of PDCA cycle management model, the quality of life, psychological status, medication compliance, and prognosis of AMI patients who underwent PCI were improved.

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Section: Discussionmentioning

confidence: 99%

Changes in the Quality of Life, Psychological Status, Medication Compliance, and Prognosis of Patients with Acute Myocardial Infarction after PCI by Applying PDCA Cycle Management Model

Hong

Liu

2021

Evidence-Based Complementary and Alternative Medicine

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“…Additionally, the incidence of clinically relevant bleeding was similar between DAPT> 1-year and DAPT≤ 1-year groups. Our previous study reported that DAPT continuation beyond 1 year offered a substantial reduction in ischemic cardiovascular events without apparent increase in clinically relevant bleeding risk compared with ≤ 1-year DAPT in patients with ESC/EACTS guideline-endorsed HTR features (19). Of note, patients with CAD and elevated Lp(a) levels had been demonstrated to be at heightened risk for ischemic events, and considered as an important group with high ischemic risk.…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective analysis of a single-center, prospective registry and the study design has been previously described (18)(19)(20). Patients with CAD and elevated Lp(a) levels who underwent PCI with DES at Fuwai Hospital, National Center for Cardiovascular Diseases between January 2013 through December 2013 were consecutively enrolled.…”

Section: Study Design and Populationmentioning

confidence: 99%

“…All the procedures and medical therapies were performed in compliance with guidelines' recommendation and operators' discretion. Detailed information on procedures has been previously described (19,20). After an overnight fasting, venous blood samples for measurement of Lp(a) and other biomarkers were obtained from all patients, and the test was conducted through clinical chemistry department in central lab of our hospital.…”

Section: Study Procedures and Biochemical Analysismentioning

confidence: 99%

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Benefit and Risk of Prolonged Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Elevated Lipoprotein(a) Concentrations

Cui

Wang

Yin

et al. 2021

Front. Cardiovasc. Med.

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Background: Lipoprotein(a) is positively related to cardiovascular events in patients with coronary artery disease (CAD). Given that lipoprotein(a) has a prothrombotic effect, prolonged dual antiplatelet therapy (DAPT) might have a beneficial effect on reducing ischemic events in patients with elevated lipoprotein(a) levels after percutaneous coronary intervention (PCI). We performed this study to assess the efficacy and safety of prolonged DAPT (>1 year) in this population.Methods: We evaluated a total of 3,025 CAD patients with elevated lipoprotein(a) levels who were event-free at 1 year after PCI from the prospective Fuwai PCI Registry, of which 913 received DAPT ≤ 1 year and 2,112 received DAPT>1 year. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction or stroke.Results: After a median follow-up of 2.4 years, patients who received DAPT>1 year were associated with lower risks of MACCE compared with DAPT ≤ 1 year (1.6 vs. 3.8%; hazard ratio [HR] 0.383, 95% confidence interval [CI] 0.238–0.616), which was primarily driven by the lower all-cause mortality (0.2 vs. 2.3%; HR 0.078, 95% CI 0.027–0.227). In addition, DAPT>1 year was also associated with lower risks of cardiac death, and definite/probable stent thrombosis than those who received DAPT ≤ 1 year (P < 0.05). Conversely, no difference was found between the two groups in terms of clinically relevant bleeding. Similar results were observed in multivariate Cox regression analysis and inverse probability of treatment weighting analysis.Conclusions: In patients with elevated lipoprotein(a) concentrations after PCI, prolonged DAPT (>1 year) reduced ischemic cardiovascular events, including MACCE, all-cause mortality, cardiac mortality, and definite/probable stent thrombosis, without increase in clinically relevant bleeding risk compared with ≤ 1-year DAPT. Lipoprotein(a) levels might be a new important consideration when deciding the duration of DAPT after PCI.

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“…Detailed information on procedures has been previously described. 20 After fasting for ≥12 hours before PCI, blood samples for measurement of Lp(a) and other biomarkers were obtained, and the test was conducted through the clinical chemistry department in our hospital. Lp(a) was measured by immunoturbidimetry method (LASAY Lp[a] auto; SHIMA Laboratories, Tokyo, Japan) with a normal range of <30 mg/dL.…”

Section: Methodsmentioning

confidence: 99%

How Do Lipoprotein(a) Concentrations Affect Clinical Outcomes for Patients With Stable Coronary Artery Disease Who Underwent Different Dual Antiplatelet Therapy After Percutaneous Coronary Intervention?

Cui

Yin

Zhu

et al. 2022

JAHA

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Background Lp(a) (lipoprotein[a]) plays an important role in predicting cardiovascular events in patients with coronary artery disease through its proatherogenic and prothrombotic effects. We hypothesized that prolonged dual antiplatelet therapy (DAPT) might be beneficial for patients undergoing percutaneous coronary intervention who had elevated Lp(a) levels. This study aimed to evaluate the effect of Lp(a) on the efficacy and safety of prolonged DAPT versus shortened DAPT in stable patients with coronary artery disease who were treated with a drug‐eluting stent. Methods and Results We selected 3201 stable patients with CAD from the prospective Fuwai Percutaneous Coronary Intervention Registry, of which 2124 patients had Lp(a) ≤30 mg/dL, and 1077 patients had Lp(a) >30 mg/dL. Patients were divided into 4 groups according to Lp(a) levels and the duration of DAPT therapy (≤1 year versus >1 year). The primary end point was major adverse cardiovascular and cerebrovascular event, defined as a composite of all‐cause death, myocardial infarction, or stroke. The median follow‐up time was 2.5 years. Among patients with elevated Lp(a) levels, DAPT >1 year presented lower risk of major adverse cardiovascular and cerebrovascular event and definite/probable stent thrombosis compared with DAPT ≤1 year. In contrast, in patients with normal Lp(a) levels, the risks of major adverse cardiovascular and cerebrovascular event and definite/probable stent thrombosis were not significantly different between the DAPT >1 year and DAPT ≤1 year groups. Prolonged DAPT had 2.4‐times higher risk of clinically relevant bleeding than shortened DAPT in patients with normal Lp(a) levels, although without statistical difference. Conclusions In stable patients with coronary artery disease, who underwent percutaneous coronary intervention with a drug‐eluting stent, prolonged DAPT was associated with reduced risk of cardiovascular events among those with elevated Lp(a) levels, whereas it did not show statistically significant evidence of benefit for reducing ischemic events and tended to increase clinically relevant bleeding among those with normal Lp(a) levels.

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Benefit-Risk Profile of DAPT Continuation Beyond 1 Year after PCI in Patients with High Thrombotic Risk Features as Endorsed by 2018 ESC/EACTS Myocardial Revascularization Guideline

Cited by 10 publications

References 45 publications

Changes in the Quality of Life, Psychological Status, Medication Compliance, and Prognosis of Patients with Acute Myocardial Infarction after PCI by Applying PDCA Cycle Management Model

Changes in the Quality of Life, Psychological Status, Medication Compliance, and Prognosis of Patients with Acute Myocardial Infarction after PCI by Applying PDCA Cycle Management Model

Benefit and Risk of Prolonged Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Elevated Lipoprotein(a) Concentrations

How Do Lipoprotein(a) Concentrations Affect Clinical Outcomes for Patients With Stable Coronary Artery Disease Who Underwent Different Dual Antiplatelet Therapy After Percutaneous Coronary Intervention?

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