Journal of Thrombosis and Thrombolysis

, Volume 44, Issue 4, pp 466–474 | Cite as

Comparison of 4 different strategies of DAPT after PCI in ACS real world population from a Northern Italy registry

  • Marta Rasia
  • Emilia Solinas
  • Massimiliano Marino
  • Paolo Guastaroba
  • Alberto Menozzi
  • Maria Alberta Cattabiani
  • Iacopo Tadonio
  • Rossana De Palma
  • Luigi Vignali
Article
  • 223 Downloads

Abstract

Aim of the study was to compare four different strategies of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes (ACS) treated with PCI. DAPT with Clopidogrel, Ticagrelor and Prasugrel has proved to be effective in patients with ACS treated with percutaneous coronary intervention (PCI) by reducing major adverse cardiovascular outcomes (MACE). However, the effect of the different strategies in a real-world population deserves further verification. A retrospective analysis of 2404 discharged ACS patients treated with PCI was performed, with a median follow-up of 1 year. The study population was stratified in four drug treatment cohorts: ASA + Clopidogrel (A-C), ASA + Plavix (A-PLx), ASA + Ticagrelor (A-T), ASA + Prasugrel (A-P). We assessed the incidence of net adverse cardiovascular events (NACE): all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), stroke and bleeding during follow-up. At 1-year, the use of A-C and A-PLx was associated with the highest cumulative incidence of NACE in comparison with A-T and A-P therapies (respectively 14.8 and 29.6% vs. 9.2 and 6%). This difference was mainly driven by the mortality and TVR outcomes. Considering selection bias and differences in the patients baseline characteristics, the association of A-T and A-P seems to be superior in comparison with a DAPT strategy of A-C and A-PLx in low risk ACS-PCI patients from real world. In our Region the prescription is consistent with guidelines recommendations and Clopidogrel and Plavix are still predominantly used in older patients with more comorbidities, and this could partially explain the inferiority of this association.

Keywords

Acute coronary syndromes Double antiplatelet therapy P2Y12 inhibitors 

Notes

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Marta Rasia
    • 1
    • 5
  • Emilia Solinas
    • 1
  • Massimiliano Marino
    • 2
  • Paolo Guastaroba
    • 3
  • Alberto Menozzi
    • 1
  • Maria Alberta Cattabiani
    • 1
  • Iacopo Tadonio
    • 1
  • Rossana De Palma
    • 4
  • Luigi Vignali
    • 1
  1. 1.Unità Operativa di CardiologiaAzienda Ospedaliero-UniversitariaParmaItaly
  2. 2.AUSL di Reggio Emilia, Governo ClinicoRegione Emilia-RomagnaItaly
  3. 3.Agenzia Sanitaria Regionale, Servizio StatisticaRegione Emilia-RomagnaItaly
  4. 4.Direzione Generale Cura della Persona, Salute, Welfare, Servizio Assistenza OspedalieraRegione Emilia-RomagnaItaly
  5. 5.Division of CardiologyParma University HospitalParmaItaly

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