TY - JOUR
T1 - Longer-term oral antiplatelet use in stable post-myocardial infarction patients
T2 - Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study
AU - TIGRIS Study Investigators
AU - Goodman, Shaun G.
AU - Nicolau, Jose C.
AU - Requena, Gema
AU - Maguire, Andrew
AU - Blankenberg, Stefan
AU - Chen, Ji Yan
AU - Granger, Christopher B.
AU - Grieve, Richard
AU - Pocock, Stuart J.
AU - Simon, Tabassome
AU - Yasuda, Satoshi
AU - Vega, Ana Maria
AU - Brieger, David
N1 - Publisher Copyright:
© 2017 Elsevier Ireland Ltd
PY - 2017/6/1
Y1 - 2017/6/1
N2 - 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.
AB - 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.
KW - Antiplatelet therapy
KW - Myocardial infarction
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U2 - 10.1016/j.ijcard.2017.02.062
DO - 10.1016/j.ijcard.2017.02.062
M3 - Article
C2 - 28268087
AN - SCOPUS:85014308918
VL - 236
SP - 54
EP - 60
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -