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  • Incidence of dual antiplatelet therapy interruption within 1 year after primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction

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Original article
Incidence of dual antiplatelet therapy interruption within 1 year after primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction
  1. Chor Cheung Tam,
  2. Jeffrey Lee,
  3. Ki Wan Chan,
  4. Cheung Chi Lam,
  5. Yiu Tung Wong,
  6. Eric Chan,
  7. Michael Sze,
  8. Yui Ming Lam,
  9. Carmen Chan,
  10. Hung Fat Tse,
  11. Chung Wah Siu
  1. Medicine, University of Hong Kong, Hong Kong, China
  1. Correspondence to Dr Chor Cheung Tam, University of Hong Kong, Hong Kong, China; frankie.tamcc{at}gmail.com

Abstract

Background After primary percutaneous coronary intervention (PPCI) in patients with acute ST elevation myocardial infarction (STEMI), dual antiplatelet therapy (DAPT) is recommended to continue for 1 year. Occasionally, DAPT interruption may be required due to bleeding issues or unplanned surgical procedures.

Objective To systematically evaluate the incidence of DAPT interruption within 1 year after PPCI.

Methods and results This was a single-centre, retrospective registry study. Consecutive patients with STEMI who underwent PPCI from 2013 to 2017 (N=538) were recruited into the analysis. The primary outcome was the incidence of interruption of DAPT within 1 year from the index PPCI. Secondary outcomes included incidence of bleeding in 1 year and prevalence of high bleeding risk (HBR) criteria at index presentation. Within 1 year, 17.1% (84/490) of post-PPCI survivors needed DAPT interruption and 7.1% (35/490) had major bleeding (Bleeding Academic Research Consortium type 3 or 5). At index presentation, HBR criteria were present in 36.1% (194/538) of patients. On univariate analysis, age, female gender, anaemia, anticoagulation, diabetes, hypertension and being a non-smoker were associated with DAPT interruption. On multivariate analysis, age was the only independent factor to predict DAPT interruption.

Conclusion DAPT interruption was not uncommon after PPCI in patients with STEMI particularly in the elderly. This has implication on stent selection during PPCI, and further studies are required to investigate which type of stent may best suit our real-life patients with STEMI.

  • myocardial infarction
  • coronary intervention

http://dx.doi.org/10.1136/postgradmedj-2019-136760

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    Footnotes

    • Contributors CCT, JL, CWS contributed to the conceptual design of the study. All authors contributed to the conduct of the study and data collection. CCT, JL, KWC, CCL, YTW, CWS contributed to the interpretation of data. CCT, JL, CWS contributed to write-up and submitted the study. All authors reviewed and agreed with the content of the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the local institutional ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.