Prevalence and clinical implications of eligibility criteria for prolonged dual antithrombotic therapy in patients with PEGASUS and COMPASS phenotypes: Insights from the START-ANTIPLATELET registry. (15th December 2021)

• Record Type: Journal Article
• Authors: Cesaro, Arturo; Gragnano, Felice; Calabrò, Paolo; Moscarella, Elisabetta; Santelli, Francesco; Fimiani, Fabio; Patti, Giuseppe; Cavallari, Ilaria; Antonucci, Emilia; Cirillo, Plinio; Pignatelli, Pasquale; Palareti, Gualtiero; Pelliccia, Francesco; Bossone, Eduardo; Pengo, Vittorio; Gresele, Paolo; Marcucci, Rossella; Schiavo, Alessandra; Vergara, Andrea; Pastori, Daniele; Menichelli, Danilo; Grossi, Guido; Di Serafino, Luigi; Taglialatela, Vittorio; del Pinto, Maurizio; Gugliemini, Giuseppe
• Is Part Of: International journal of cardiology. Volume 345(2021)
• Page Start: 7
• Page End: 13
• Publication Date: 2021-12-15
• Subjects: Dual antiplatelet therapy (DAPT) -- Dual antithrombotic therapy -- Ticagrelor -- Rivaroxaban -- Acute coronary syndrome (ACS) -- Chronic coronary syndrome (CCS); Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.10.138
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aim: To analyze the prevalence and clinical implications of the eligibility criteria for prolonged dual antithrombotic therapy with ticagrelor 60 mg twice daily and/or rivaroxaban 2.5 mg twice daily in a contemporary real-world ACS registry. Methods: Patients from the START-ANTIPLATELET registry (NCT02219984 ) were stratified according to the eligibility criteria of the PEGASUS and COMPASS studies to investigate the proportion of patients eligible for prolonged dual antithrombotic therapy at discharge and after 1-year of DAPT. Net adverse clinical events (NACE), defined as all-cause death, myocardial infarction, stroke, and major bleeding, at 1 year were also evaluated and compared among groups. Results: 1844 were considered for the analysis at baseline. Out of 849 event-free patients continually receiving dual antiplatelet therapy for at least 1 year, 577 (68%) and 583 (68.7%) met at least one eligibility criterion for ticagrelor and rivaroxaban, respectively. In the PEGASUS-like patients, age was the most common criterion (71% of cases). The presence ≥2 cardiovascular risk factors was the most common eligibility criterion in the COMPASS-like patients (80.8%). At 1-year follow-up, 211 (11.4%) and 119 (6.5%) patients experienced NACE and MACE, respectively. The incidence of NACEs was higher in the PEGASUS-only group (15.4% vs. 8.4%; p = 0.008) and numerically higher in the COMPASS-only group (10.9% vs. 8.4%; p = 0.299). Conclusions: In a contemporary real-world ACS cohort, approximately two-thirds of patients that complete 1-year DAPT met the eligibility criteria for ticagrelor 60 mg twice daily or rivaroxaban 2.5 mg twice daily, showing a higher risk of NACEs. Graphical abstract: Unlabelled Image Highlights: In a real-world ACS cohort, two-thirds of patients met the eligibility criteria for prolonged DAT after 1-yr follow-up. In the PEGASUS-like patients, age (71%) was the most common criterion for eligibility to ticagrelor 60 mg bid. In the COMPASS-like patients, the presence of at least 2 risk factors represented the most common criterion for eligibility. The group of patients identified by PEGASUS criteria showed a higher risk of NACE than non-eligible patients.