Clinical Impact of Single and Dual Antiplatelet Therapy Beyond 12 Months on Ischemic Risk in Patients With Acute Myocardial Infarction

Ji Woong Roh; SungA Bae; Yongcheol Kim; Nak-Hoon Son; Deok-Kyu Cho; Jung-Sun Kim; Byeong-Keuk Kim; Donghoon Choi; Myeong-Ki Hong; Myung Ho Jeong; Yangsoo Jang; KAMIR-NIH Investigators

doi:10.3389/fcvm.2021.783344

Clinical Impact of Single and Dual Antiplatelet Therapy Beyond 12 Months on Ischemic Risk in Patients With Acute Myocardial Infarction

Front Cardiovasc Med. 2021 Nov 24:8:783344. doi: 10.3389/fcvm.2021.783344. eCollection 2021.

Authors

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital and Cardiovascular Center, Yonsei University College of Medicine, Yongin, South Korea.
² Division of Biostatistics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea.
³ Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam University College of Medicine, Gwangju, South Korea.
⁵ Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.

Abstract

Background: There is ongoing debate regarding the optimal antiplatelet strategy beyond 12 months in patients with acute myocardial infarction (AMI) who undergo successful percutaneous coronary intervention (PCI). This study therefore aimed to investigate the clinical outcomes of single (SAPT) vs. dual antiplatelet therapy (DAPT) beyond 12 months in patients with stable AMI and second-generation drug-eluting stent (DES) implantation. Methods: Of 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, we selected 4,604 patients who underwent PCI with second-generation DES and exhibited no adverse clinical events within 12 months; they were classified into SAPT (aspirin or clopidogrel) or DAPT (aspirin and clopidogrel) groups. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE), including the composite of all-cause death, myocardial infarction (MI), and stroke between 12 and 36 months. Results: The SAPT group (n = 1,862) was associated with a significantly lower risk of MACCE between 12 and 36 months [4.2 vs. 8.5%, hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.37-0.61; p < 0.001] than the DAPT group (n = 2,742). The results were consistent after adjusting for confounders through multivariable and propensity score matching analysis. Moreover, in patients with complex features (defined as an unprotected left main PCI, implanted stent length of ≥38 mm, multivessel PCI, or ≥3 stents per patients), the SAPT group (n = 678) also demonstrated a significantly lower risk of MACCE between 12 and 36 months (4.9 vs. 9.9%, HR: 0.46, CI: 0.31-0.68, p < 0.001) than the DAPT group (n = 1,167). Conclusions: In patients with AMI who underwent successful PCI with second-generation DES and exhibited no adverse clinical events within 12 months, the use of SAPT was associated with a significantly lower MACCE between 12 and 36 months compared with the use of DAPT.

Keywords: acute myocardial infarction; antiplatelet therapy; aspirin; clopidogrel; major adverse cardiac and cerebral event.