Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study.
Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study.
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DOI：
10.1055/s-0038-1676529
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发表时间：
2018-10-01
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影响因子：
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通讯作者：
Rossini, Roberta
中科院分区：
文献类型：
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作者：
Degli Esposti, Luca;Perrone, Valentina;Rossini, Roberta
这项研究的目的是评估急性心肌梗死(AMI)后接受双重抗血小板治疗(DAPT)出院的真实患者的长期药物依从性和预后。使用8个地方卫生单位保存的行政数据库进行了回溯性队列分析。在36个月的随访中，分析了DAPT暴露(定义为≥2处方)、依从性和主要不良事件(MACE)的发生情况。这项分析包括11,101名最初诊断为急性心肌梗死的活着出院的患者。在这些患者中，5919名患者(53.31%)在没有被诊断为癌症或贫血、没有短暂停止DAPT的情况下出院，这代表了研究人群。前6个月和12个月分别有2200名患者(37.2%)和1,995名(33.7%)患者停止使用DAPT，而36月后仍在使用DAPT的患者有423名(7.1%)。与6个月后停止DAPT的患者相比，维持DAPT长达12个月的患者总体死亡率显著降低。接触DAPT 3年的患者全因死亡率降低(危险比[HR]：0.067，95%可信区间[CI]：0.027-0.162，p
The aim of this study was to assess long-term drug adherence and prognosis in real-world patients discharged on dual-antiplatelet therapy (DAPT) after acute myocardial infarction (AMI). A retrospective cohort analysis using administrative databases kept by eight local health units was performed. DAPT exposure (defined as≥2 prescriptions), adherence, and the occurrence of major adverse events (MACE) were analyzed during a 36-month follow-up. The analysis included 11,101 patients who were discharged alive with a primary diagnosis of AMI. Of these, 5,919 patients (53.31%) were discharged on DAPT without a diagnosis of cancer or anemia, without transient DAPT discontinuation, and represented the study population. DAPT discontinuation occurred in 2,200 patients (37.2%) and in 1,995 (33.7%) after the first 6 and 12 months, respectively, whereas 423 patients (7.1%) were still on DAPT after 36 months. Patients who maintained DAPT up to 12 months had a significantly lower overall mortality, compared with patients who discontinued DAPT after 6 months. Exposure to DAPT at 3 years was associated with reduced all-cause mortality (hazard ratio [HR]: 0.067, 95% confidence interval [CI]: 0.027-0.162, p