Abstract 17279: Is Prolonged Dual Antiplatelet Therapy after AMI Associated with Improved Long-Term Survival? Five-Year Follow-Up Data from the French FAST-MI 2005 Registry
Background and aim: Prospective trials of dual antiplatelet therapy (DAPT) after AMI have shown a clinical benefit at year. Beyond one year, however, little is known about the potential impact of prolonging DAPT after AMI. We assessed 5-year mortality in AMI patients included in the FAST-MI registry who received DAPT one year after the index event, according to whether DAPT was still used at 3 years or not.
Methods: FAST-MI is a French nationwide registry of patients hospitalized within 48 hours of STEMI or NSTEMI, at the end of 2005 in 223 institutions representing 60% of all French institutions taking care of AMI patients. Of the 3,670 patients included, 3,463 were discharged alive. 5-year follow-up was available in 95% of the patients. Detailed information on medications prescribed at discharge, one year and 3 years was available in 2275 patients, of whom 1040 received DAPT at one year and were alive at 3 years. Of those, 430 were still on DAPT at 3 years (DAPT long) and 610 had stopped DAPT after 1 year and received only one antiplatelet agent at 3 years (DAPT short).
Results: DAPT long and DAPT short patients had similar profiles (age: 63 ± 12 yrs; women: 22% vs 27%; PCI during initial stay: 86 vs 87%; use of DES: 41 vs 37%; LVEF: 54 ± 12 vs 55 ± 12%; GRACE score 137 ± 30 vs 138 ± 31; statin Rx at 3 years: 91 vs 89%). Five-year mortality in 3-year survivors was 4.9% in DAPT long and 2.8% in DAPT short pts (P=0.07). The HR for 5-year death in pts with prolonged DAPT, adjusted for age, sex, clinical profile, medical history, in-hospital treatment and complications, discharge medications, and recurrent MI within 3 years was 1.18 (95%CI: 0.54-2.58; P=0.67).
Conclusion: in this real-world nationwide registry, 5-year mortality in pts with prolonged DAPT was marginally higher than in patients switching to single antiplatelet therapy after one year. After multivariate adjustment, there was still no evidence of a lower risk for patients with prolonged DAPT. These findings do not suggest that DAPT with clopidogrel should be maintained beyond one year.
- © 2012 by American Heart Association, Inc.