Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study

Objective To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions. Methods Patients ≥ 50 years with prior MI 1–3 years ago and ≥ 1 risk factor (age ≥ 65 years, diabetes, 2nd prior MI > 1 yr ago, multivessel CAD, creatinine clearance 15–<60 ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013–14) in the prospective TIGRIS study (NCT01866904). Results 9225 patients were enrolled (median 1.8 years) post-MI: 52% with prior ST-elevation MI, median age 67 years, 24% women, 67% Caucasian, 55% had ≥ 2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥ 140/90 mm Hg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA] + ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1 year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6 years); continued DAPT > 1 year was highest (39%) in Asia-Pacific and lowest (12%) in Europe. Conclusions Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~ 1 year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT > 1 year post-MI/PCI, > 1 in 4 patients have continued on DAPT, though with substantial international variability.