Abstract 16705: EPICOR: An International Study of the Duration of Dual Antiplatelet Therapy in Survivors of Acute Coronary Syndromes
Aim: To describe current international patterns of use of dual antiplatelet therapy (DAPT) after discharge in patients surviving hospitalization for acute coronary syndromes (ACS).
Methods: EPICOR (NCT01171404) was a prospective international observational study which enrolled 10,568 patients with ACS (4943 STEMI, 5625 NSTEACS) in 555 hospitals from 20 countries across Europe and Latin-America between September 2010, and March 2011, designed to describe the acute and chronic use of antithrombotic therapies. Patients were interviewed by telephone about use and changes in antiplatelet therapy at 3, 6, 9, 12, 15, 18, 21 and 24 months. This is a descriptive analysis of the patterns of DAPT during the 2 years following discharge.
Results: At discharge, 8890 patients (87.8%) of the 10,568 patients initially enrolled were on DAPT (91.5% with aspirin+clopidogrel, 8.3% aspirin+prasugrel). At 12 months, 82.9% of available patients for long-term analysis (not dead or lost to FU) were still on DAPT, 15.7% were on single antiplatelet therapy (12.4% aspirin, 3.3% other) and 1.4% without antiplatelets. At 2 years, 61.9% were on DAPT, 35.2% on single antiplatelet therapy (30.2% aspirin, 5% other) and 2.9% without (Figure 1). There were minor differences in the proportion of patients on DAPT at 2 years according to type of ACS (61.7% in STEMI, 62.1% in NSTEACS; p=0.38), age (61.8% ≥65 vs 62.0% <65 years; p=0.93), gender (62.2% in men, 61.1% in women; p=0.60), diabetes (64.0% vs 61.3%; p=0.05) or therapeutic strategy used in hospital (medical therapy 60.9%, PCI 62.6%, CABG 57.1%; p=0.49), with the exception of P2Y12 inhibitor (51.5% with prasugrel, 62.8% with clopidogrel; p<0.001), and region (maximum 65.9% in Latin America, minimum 55.7% in Southern Europe; p<0.001).
Conclusions: EPICOR is the first large study showing that, despite guidelines recommendations, a large proportion of patients in Europe and Latin America remain on DAPT after the first 12 months past the index event.
Author Disclosures: H. Bueno: Research Grant; Modest; AstraZeneca. Consultant/Advisory Board; Modest; AstraZeneca, Bayer, BMS, Daichii-Sankyo, Eli-Lilly, Novartis, Pfizer, Sanofi, Roche. S. Pocock: Research Grant; Modest; AstraZeneca. N. Danchin: Consultant/Advisory Board; Modest; AstraZeneca, BMS, Boeringer-Ingelheim, GlaxoSmithKline, MSD-Schering-Plough, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi-Aventis, Servier, Takeda, The Medicines Company. L. Annemans: Consultant/Advisory Board; Modest; AstraZeneca. J. Medina: Employment; Significant; AstraZeneca. M. Millegård: Employment; Significant; AstraZeneca. F. Van de Werf: Research Grant; Modest; Boehringer Ingelheim, Merck. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Merck, Roche, Sanofi-Aventis, AstraZeneca, The Medicines Company.
- © 2014 by American Heart Association, Inc.