Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients

Tizón-Marcos, Helena; Toloba, Andrea; Subirana Cachinero, Isaac; Elosua Llanos, Roberto; Marrugat de la Iglesia, Jaume

doi:http://dx.doi.org/10.1016/j.rec.2022.12.003

Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients

Citation

Tizón-Marcos H, Toloba A, Subirana Cachinero I, Elosua R, Sionis A, Fernández-Avilés F, et al. Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients. Rev Esp Cardiol (Engl Ed). 2023 Jul;76(7):548-54. DOI: 10.1016/j.rec.2022.12.003

Abstract

Introduction and objectives: Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. Methods: We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients. Results: A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P <.01), respectively, whereas noncardiovascular mortality was 3.3% vs 5.8% (P=.049) at 5 years. Cardiovascular readmission or mortality in patients with single antiplatelet therapy vs DAPT was 11.4% vs 46.5% (P <.001). Extended DAPT was independently associated with worse 5-year all-cause mortality (HR, 2.16; 95%CI, 1.40-3.33), cardiovascular mortality (HR, 2.83; 95%CI, 1.37-5.84), and cardiovascular readmission or mortality (HR, 5.20; 95%CI, 3.96-6.82). These findings were confirmed in propensity score matching and inverse probability weighting analyses. Conclusions: Our results suggest the hypothesis that, in 1-year STEMI survivors, extending DAPT up to 5 years in high-risk patients does not improve their long-term prognosis.