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. 2022 Apr 8;11(8):2091.
doi: 10.3390/jcm11082091.

A Therapeutic Pathway in Patients with Chronic Coronary Syndromes: Proposal for Optimization

Raffaele De Caterina  1   2   3 , Paolo Calabrò  4   5 , Gianluca Campo  6 , Roberta Rossini  7 , Simona Giubilato  8
Affiliations

A Therapeutic Pathway in Patients with Chronic Coronary Syndromes: Proposal for Optimization

Raffaele De Caterina et al. J Clin Med. .

Abstract

There is uncertainty in cardiologists’ attitudes for prolonging dual antiplatelet therapy (DAPT) with ticagrelor 60 mg beyond 12 months in post-myocardial infarction (MI) patients. We aimed at characterizing the Italian cardiologists’ perceptions and needs in the management of such patients. Two consecutive questionnaires were proposed between June and November 2021, and compiled by 122 and 87 Cardiologists, respectively. Agreement among cardiologists was defined as either a >70% frequency of concordant responses relative to total respondents or following the Delphi method as developed by the RAND Corporation. An agreement was reached on the indication of ticagrelor as the first choice P2Y12 inhibitor in MI patients, irrespective of the presentation [ST elevation MI (STEMI), 72%, vs. non-ST elevation MI (NSTEMI), 71%] or the management [invasive vs. conservative (75%)]. A consensus was also achieved on the possibility to consider a patient suitable for long-term DAPT with ticagrelor 60 mg even in case of another P2Y12 inhibitor used in the first year after the acute event (74, 85%). To define ischemic and bleeding risks, a consensus was reached on the utilization of one or more scores (87, 71%).

Keywords: dual antiplatelet therapy; myocardial infarction; ticagrelor.

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Conflict of interest statement

R.D.C. co-authored ESC Guidelines on Atrial Fibrillation 2010–2012; acted as a Steering Committee member and National Coordinator for Italy, and co-authored manuscripts published on APPRAISE-2, ARISTOTLE, AVERROES, ENGAGE AF-TIMI 48, Re-DUAL PCI and ETNA-AF. RDC has received fees, honoraria and research funding from AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Bayer, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Novartis, Portola, Roche and Merck. G.C. received fees and research grants from AstraZeneca, Abbott vascular, Boston Scientific, Amgen, Daichii Sankyo, SMT, Eukon, Sanofi. P.C. received fees and research grants from AstraZeneca, Amgen, Daichii Sankyo, Sanofi, Chiesi. R.R. received fees and research grants from AstraZeneca, Bayer, Chiesi, Novartis, Pfizer. S.G. has no conflict to declare.

Figures

Figure 1
Figure 1
Respondents’ indication of the first-choice P2Y12 inhibitor in all acute coronary syndrome clinical settings. (A): Indication of the first-choice P2Y12 inhibitor in ST-segment elevation myocardial infarction (STEMI). (B): Indication of the first-choice P2Y12 inhibitor in non ST-segment elevation myocardial infarction (NSTEMI). (C): Indication of ticagrelor percentage of use in NSTEMI conservatively managed.
Figure 1
Figure 1
Respondents’ indication of the first-choice P2Y12 inhibitor in all acute coronary syndrome clinical settings. (A): Indication of the first-choice P2Y12 inhibitor in ST-segment elevation myocardial infarction (STEMI). (B): Indication of the first-choice P2Y12 inhibitor in non ST-segment elevation myocardial infarction (NSTEMI). (C): Indication of ticagrelor percentage of use in NSTEMI conservatively managed.
Figure 2
Figure 2
(A): Overall utilization of scores in clinical practice. (B): Main scores utilized in clinical practice overall. (C): Main scores utilized in clinical practice to estimate ischemic risk (%). (D): Main scores utilized in clinical practice to estimate bleeding risk (%).
Figure 2
Figure 2
(A): Overall utilization of scores in clinical practice. (B): Main scores utilized in clinical practice overall. (C): Main scores utilized in clinical practice to estimate ischemic risk (%). (D): Main scores utilized in clinical practice to estimate bleeding risk (%).
Figure 3
Figure 3
Most relevant elements considered in order to prolong DAPT at 12 months.
Figure 4
Figure 4
Main barriers to long-DAPT prescription in post-MI CCS patients in clinical practice.
Figure 5
Figure 5
Possible actions aimed at the implementation of follow-up and cure in post-MI CCS patients.
See this image and copyright information in PMC

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