Dual antiplatelet therapy is under-prescribed in patients with surgically treated acute myocardial infarction. (25th June 2021)

• Record Type: Journal Article
• Authors: Roberto, Marco; Radovanovic, Dragana; Buttà, Carmelo; Tersalvi, Gregorio; Krüll, Joël; Erne, Paul; Rickli, Hans; Pedrazzini, Giovanni Battista; Moccetti, Marco
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 33:Number 5(2021)
• Page Start: 687
• Page End: 694
• Publication Date: 2021-06-25
• Subjects: Acute myocardial infarction -- Coronary artery bypass graft -- Dual antiplatelet therapy -- Clopidogrel -- Ticagrelor -- Prasugrel; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab159
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: Despite guideline recommendations, previous reports, coming mainly from outside Europe, showed low rates of prescriptions for dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) undergoing surgical revascularization. The present study assesses this issue in the era of potent P2Y12 inhibitors in Switzerland. METHODS: All patients with a diagnosis of AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry from January 2014 to December 2019 were screened; 9050 patients undergoing either percutaneous (8727, 96.5%) or surgical (323, 3.5%) revascularization were included in the analysis. RESULTS: Surgically treated patients were significantly less likely to receive DAPT at discharge (56.3% vs 96.7%; P < 0.001). Even when discharged with a prescription for DAPT, those patients were significantly less likely to receive a regimen containing a new P2Y12 inhibitor (67/182 [36.8%] vs 6945/8440 [83.2%]; P < 0.001). At multivariate analysis, surgical revascularization was independently associated with a lower likelihood of receiving a prescription for DAPT at discharge (odds ratio 0.03, 95% confidence interval 0.02–0.06). CONCLUSIONS: DAPT prescriptions for patients with AMI undergoing surgical revascularization are not in line with current guideline recommendations. Efforts are necessary to clarify the role of DAPT for secondary prevention in these patients and increase the confidence of treating physicians in guideline recommendations. Clinical trial registration: Acute Myocardial Infarction in Switzerland Plus Registry; registration number at ClinicalTrials.gov: NCT01305785. Abstract : Twelve months of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor represent the cornerstone of secondary prevention in acute coronary syndrome (ACS) [1–5].