Discontinuation of Dual Antiplatelet Therapy Over 12 Months after Acute Coronary Syndromes Increases Risk for Adverse Events in Patients Treated with Percutaneous Coronary Intervention: Systematic Review and Meta‐Analysis

D’Ascenzo, Fabrizio; Colombo, Francesco; Barbero, Umberto; Moretti, Claudio; Omedè, Pierluigi; Reed, Matthew J; Tarantini, Giuseppe; Frati, Giacomo; Nicolantonio, James J. Di; Biondi‐Zoccai, Giuseppe; Gaïta, Fiorenzo

doi:10.1111/joic.12107

Cited by 33 publications

(23 citation statements)

References 48 publications

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“…When the vast majority of patients were prescribed cholesterol and BP lowering drugs, and only 40-55% reached treatment targets, it is possible that the drugs chosen were not the optimal, the dosages applied were too low, the patients were not compliant or a combination. The clinical significance of long-term dual anti-platelet therapy after coronary stent procedures was recently documented in CHD [30], reflecting the need for improved secondary prevention programs that also address drug-adherence reliability and over time (>12 months).…”

Section: Discussionmentioning

confidence: 99%

Unfavourable risk factor control after coronary events in routine clinical practice

Sverre

Peersen

Husebye

et al. 2017

BMC Cardiovasc Disord

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BackgroundRisk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event.MethodsA cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up.ResultsTwenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed.ConclusionsThe majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits.Trial registrationRegistered at ClinicalTrials.gov (ID NCT02309255).Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0387-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Unfavourable risk factor control after coronary events in routine clinical practice

Sverre

Peersen

Husebye

et al. 2017

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…On the other hand, a recent meta-analysis of almost 50,000 patients by D'Ascenzo et al 39 showed that ACS patients undergoing PCI suffered more adverse events compared to ACS patients treated medically if they stopped DAPT after a year. Although they concluded that this result was hypothesis generating, it supports the fact that high-risk patients would need a tailored approach to the duration of DAPT.…”

Section: Discussionmentioning

confidence: 99%

Safety of short-term dual antiplatelet therapy after drug-eluting stents: An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials

Bulluck

Kwok

Ryding

et al. 2015

International Journal of Cardiology

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“…The rate of use of dual antiplatelet therapy at 2-year was 44.9%. It is possible that the relatively higher rate of use of dual antiplatelet therapy contributes the low rate of stent thrombosis [32,33]. As compared with the first-generation DES [10], the use of second-generation DES may reduce the possibility of late or very late stent thrombosis, but it need to be explained in future trials.…”

Section: Discussionmentioning

confidence: 99%

Biodegradable polymer biolimus-eluting stent versus durable polymer everolimus-eluting stent in patients with acute myocardial infarction

Lee

Park

Song

et al. 2015

International Journal of Cardiology

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Discontinuation of Dual Antiplatelet Therapy Over 12 Months after Acute Coronary Syndromes Increases Risk for Adverse Events in Patients Treated with Percutaneous Coronary Intervention: Systematic Review and Meta‐Analysis

Cited by 33 publications

References 48 publications

Unfavourable risk factor control after coronary events in routine clinical practice

Unfavourable risk factor control after coronary events in routine clinical practice

Safety of short-term dual antiplatelet therapy after drug-eluting stents: An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials

Biodegradable polymer biolimus-eluting stent versus durable polymer everolimus-eluting stent in patients with acute myocardial infarction

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