Dual Anti-Platelet Therapy

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Editorial

The Choice of Antiplatelet Dual Combination in Coronary Artery Disease: Is this Just a Question of Balance between ischemic Burden and Bleeding Risk?

Maria Cristina Almeida et al. Marildes Luiza de Castro Larissa Neto Espíndola

Acute or chronic coronary syndrome is one of the most important threats to public health. Because of structural and/or functional alterations of the coronary arteries and/or microcirculation, it can culminate in disbalance between myocardial demand and blood supply resulting in ischemia.

Primary prevention of acute coronary ischemic events based on lowering the risk of coronary artery occlusion is a very important measurement. Secondary prevention after myocardial revascularization by percutaneous coronary intervention (PCI) with stent is important to reduce the risk of stent thrombosis, ischemic events and myocardial infarction (MI), particularly early after stenting. Many protocols have been studied, but the dual antiplatelet therapy (DAPT) with aspirin plus a potent P2Y12 inhibitor is the current standard of care after PCI.

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Original Article

Fixed-Dose Antiplatelet Dual Combination in Patients with Coronary Artery Disease in Turkish Population: DAPT-TR

Ahmet Öz et al. Kenan Toprak Ertan Aydin İbrahim Saraç … Mustafa Doğduş Selçuk Opan Mustafa Yenerçağ Mustafa Begenc Tascanov Ömer Kümet Miraç Karaağaç Murat Özmen Bektaş Murat Ömer Kertmen Özkan Bekler Sinan İnci Mustafa Ahmet Huyut Ahmet Özderya Fahri Er Mustafa Duran İsa Ardahanlı Mehmet Memduh Baş Tuncay Güzel Gökhan Ceyhun İbrahim Halil Özdemir Mehmet Burak Özen Ramazan Gündüz Aslan Erdoğan İlyas Çetin Veysel Özgür Barış Çağrı Yayla Medeni Karaduman Lütfü Aşkın Lütfü Bekar Okan Tanrıverdi Eyüp Özkan Emrah Yeşil Serhat Çalışkan Zülfiye Kuzu Berat Uğuz Ferit Böyük Ayşegül Ülgen Kunak Selda Murat Serkan Asil Özkan Kayhan Emrah Erdoğan Ramazan Duz Fahrettin Katkat Tuba Ekin Ersin İbişoğlu Bilge Nazar Ateş Burak Ayça Asım Oktay Ergene Mehdi Zoghi

Abstract

Background

Dual antiplatelet therapy (DAPT) is the treatment of choice for patients with acute and chronic coronary syndromes as it reduces mortality and prevents recurrent thrombotic complications. The assessment of both ischaemic burden and bleeding risk is crucial in deciding which DAPT to choose and how long it should be continued.

Objectives

The aim of our study was to perform prospective clinical follow-up of patients receiving fixed-dose combination therapy (ASA 75 mg + clopidogrel 75 mg). Our study is a multicentric, cross-sectional, observational, cohort study.

Methods

A total of 1500 patients who were started on fixed-dose combination DAPT for acute or chronic coronary syndrome were included in the study. Primary endpoints were hospitalization for any reason, hospitalization for cardiovascular cause, acute myocardial infarction, stent thrombosis, target vessel revascularization and bleeding; the secondary endpoints were death for any reason or cardiovascular cause and stroke. The significance level adopted in the statistical analysis was 5%.

Results

Median age was 63 years; 78.5% of the patients were receiving DAPT treatment for acute coronary syndrome. The rates of hospitalization for cardiovascular reasons, acute myocardial infartion, stent thrombosis and target-vessel revascularization were 7.9%, 2.3%, 1.3% and 4.2%, respectively. While the rate of BARC type 1 bleeding was 3.3%, the rate of BARC type 5, 3, or 2 bleeding was 0.6%. The secondary endpoints which were death from any cause, cardiovascular death and stroke were 0.5%, 0.3% and 0.3%, respectively. Conclusion: Our study shows that fixed-dose combination therapy is effective and safe in appropriately selected patients with acute or chronic coronary syndromes.

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Original Article

Prognostic Value of PRECİSE DAPT Score on Short- and Long-Term Outcomes in MINOCA Patients with Acute Coronary Syndrome

Tolga Onuk et al. Fuat Polat Bariş Yaylak Ali Nazmi Çalik … Semih Eren Şükrü Akyüz

Abstract

Background

Myocardial infarction with non-obstructive coronary arteries (MINOCA) constitutes a significant subset of acute myocardial infarctions (AMI) with uncertain prognostic markers. Early risk assessment is crucial to identify MINOCA patients at risk of adverse outcomes.

Objectives

This study aimed to evaluate the predictive capacity of the PRECISE-DAPT score in assessing short- and long-term prognoses in MINOCA patients presenting with ST-segment elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI).

Methods

Among 741 MINOCA patients, the PRECISE-DAPT score was computed to analyze its association with in-hospital and follow-up major adverse cardiovascular events (MACE). Parameters showing significance in MACE (+) groups underwent statistical analysis: univariate logistic regression for in-hospital events and univariate Cox regression for follow-up events. For statistical significance, a predefined level of α = 0.05 was adopted. Parameters demonstrating significance proceeded to multiple logistic regression for in-hospital events and multivariate Cox regression for follow-up events.

Results

In-hospital MACE occurred in 4.1% of patients, while 58% experienced follow-up MACE. Hemoglobin levels and the PRECISE-DAPT Score were identified as independent parameters for in-hospital MACE. Furthermore, ejection fraction (EF%) and the PRECISE-DAPT Score emerged as independent predictors of follow-up MACE.

Conclusions

The study revealed that a higher PRECISE-DAPT score was significantly associated with increased risks of both in-hospital and long-term major adverse cardiovascular events in MINOCA patients presenting with acute coronary syndrome (ACS), underscoring the score’s potential in risk stratification for this patient cohort.

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The Choice of Antiplatelet Dual Combination in Coronary Artery Disease: Is this Just a Question of Balance between ischemic Burden and Bleeding Risk?

Fixed-Dose Antiplatelet Dual Combination in Patients with Coronary Artery Disease in Turkish Population: DAPT-TR

Abstract

Background

Objectives

Methods

Results

Prognostic Value of PRECİSE DAPT Score on Short- and Long-Term Outcomes in MINOCA Patients with Acute Coronary Syndrome

Abstract

Background

Objectives

Methods

Results

Conclusions

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