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Observational Study
. 2019 Nov;42(11):1113-1120.
doi: 10.1002/clc.23262. Epub 2019 Aug 31.

How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Leonardo De Luca  1 , Furio Colivicchi  2 , Jennifer Meessen  3 , Massimo Uguccioni  4 , Federico Piscione  5 , Paola Bernabò  6 , Gerardina Lardieri  7 , Antonino Granatelli  1 , Domenico Gabrielli  8 , Michele M Gulizia  9   10 ; EYESHOT Post-MI Investigators
Collaborators, Affiliations
Observational Study

How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Leonardo De Luca et al. Clin Cardiol. 2019 Nov.

Abstract

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI).

Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year.

Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event.

Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit.

Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI.

Keywords: clopidogrel; dual antiplatelet therapy; percutaneous coronary intervention; post-MI; secondary prevention; ticagrelor.

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Conflict of interest statement

L.D.L. reports personal fees from Astra Zeneca and Daiichi Sankyo outside the submitted work. All other authors have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Figures

Figure 1
Figure 1
Patients flow‐chart
Figure 2
Figure 2
Use of scores for the assessment of ischemic or bleeding risk
Figure 3
Figure 3
Multivariable analysis on DAPT assumption at the time of enrolment for patients in the second (Panel A) and third (Panel B) year from the last MI and after cardiologist assessment for patients in the second (Panel C) and third (Panel D) year from the last MI
See this image and copyright information in PMC

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