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Antiplatelet Therapy For Acute Coronary Syndrome
Antiplatelet Therapy For Acute Coronary Syndrome
Hippocrates
1897 AD
1900 present
1971
the
Duration of Dual
Anti-Platelet
Therapy
PCI-CURE
CV Death or MI
CHARISMA
Instantaneous Hazard for Moderate or Severe Bleeding
CHARISMA
Primary End Point
TRILOGY-ACS
Primary Efficacy End Point to 30 Months (Age < 75 years)
DAPT Trial
Total Enrollment
DES vs BMS
DAPT Trials
Unanswered Questions
OPTIMIZE
Second-generation DES
Effect of Short- and Long-term DAPT
y
gistr
e
R
S
PARI
PARIS Registry
Patterns of Non-Adherence to
Anti-Platelet Regimens In Stented
Patients: An Observational
Single Arm Study
Medication Usage
tr
egis
R
S
I
PAR
3582
(71.1%)
2014
(40.0%)
991
(19.7%)
1894
(37.6%)
47 (0.9%)
5012
(99.6%)
5031
(100%)
1177
(23.4%)
5012
(99.6%)
311 (6.2%)
Procedural Information
tr
egis
R
S
I
PAR
Stents by Type
tr
egis
R
S
I
PAR
Thienopyridine at Discharge
tr
egis
R
S
I
PAR
Rates of Non-Adherence
(Patient-level)
tr
egis
R
S
I
PAR
Incidence of Non-Adherence
tr
egis
R
S
I
PAR
Any Non-Adherence
Variable
Any Non-adherence
Disruption, n (%)
Patients Episodes
104 (2.1)
147
72 (69)
102 (70)
27 (18)
Discontinuation, n
12 (12)
(%)
18 (12)
Incidence of NonAdherence
(Cont.)
tr
egis
R
S
I
PAR
Patients Episodes
Any Non-adherence,
n (%)
66 (1.3)
69
Disruption, n (%)
43 (65)
46 (67)
12 (17)
Discontinuation, n
11 (17)
(%)
11 (16)
Incidence of NonAdherence
(Cont.)
tr
egis
R
S
I
PAR
Patients Episodes
Any Non-adherence,
n (%)
70 (1.4)
78
Disruption, n (%)
51 (73)
56 (72)
15 (19)
Discontinuation, n
(%)
7 (10)
7 (9)
Bleeding
ASA
Thienopyridine
18
14
NonCompliance
34
30
Other
4
2
tr
egis
R
S
I
PAR
Surger
y
ASA
5
Thienopyridi
5
ne
Other Medical
Procedure
(epidural, catheter removal, GI
Scope)
2
3
Coumad
GI Upset Allergy
in
3
3
2
0
4
0
Non-Adherence guided by
healthcare professionals
tr
egis
R
S
I
PAR
Baseline Characteristics
tr
egis
R
S
I
PAR
Variable
Adherent
n=4929
Age, years
63.94 [11.33]
Male, n (%)
Acute coronary syndrome, n
(%)
Diabetes Mellitus, n (%)
Dyslipidemia, n (%)
Hypertension, n (%)
Peripheral Vascular
Disease, n (%)
Prior coronary artery
disease, n (%)
Prior MI, n (%)
Nonadherent
n=104
3676 (74.6)
1987 (40.5)
64.83
[11.31]
74 (71.2)
60 (58.3)
1627
3744
3944
387
36
66
76
9
(33.0)
(76.0)
(80.0)
(7.9)
(34.6)
(63.5)
(73.1)
(8.7)
p-value
0.42
0.43
<0.0001
0.73
0.003
0.08
0.76
1987 (40.5)
60 (58.3)
<0.0001
1201 (24.4)
19 (18.3)
0.15
tr
egis
R
S
I
PAR
Timeframe
Population
DAPT
Discontinuation
at 30 days (%)
Airoldi et al1
2002 2004
3021
2.4%
PREMIER
Registry2
2003 2004
DES for MI
500
13.6%
MATRIX
Registry3
2004-2006
1504
5.8%
E-Five Registry4
2005-2007
7988
2.1%
E-SELECT
Registry5
2006-2008
14,365
2%
Study
1.
2.
3.
4.
5.
tr
egis
R
S
I
PAR
Adherent Non-adherent
(n=4929)
(n=104)
Ischemic
MACE, n (%)
78 (1.5)
67 (1.4)
11 (10.6)
17 (0.3)
15 (0.3)
2 (1.9)
15 (0.3)
14 (0.3)
1 (1.0)
54 (1.1)
46 (0.9)
8 (7.7)
26 (0.5)
23 (0.5)
3 (2.9)
TVR, n (%)
30 (0.6)
25 (0.5)
5 (4.8)
TLR, n (%)
23 (0.5)
19 (0.4)
4 (3.8)
9 (0.2)
6 (0.1)
3 (2.9)
35 (0.7)
23 (0.5)
12 (11.5)
BARC 3, n (%)
30 (0.6)
18 (0.4)
12 (11.5)
Myocardial
(%)
Infarction, n
Bleeding
TIMI major, n (%)
BARC Classification
N (% of total population)
26 (0.5)
37 (0.7)
Type 3
30 (0.6)
3a
15 (0.3)
3b
15 (0.3)
3c
Stent Thrombosis
tr
egis
R
S
I
PAR
Stent Thrombosis
(n=26)
Probable (n=9)
Definite (n=17)
Adherent (n=14)
Non-adherent (n=3)
Disrupted ASA
(n=2)
Disrupted
Clopidogrel (n=1)
tr
egis
R
S
I
PAR
Non-Adherent
RR
PARIS Registry
0.5%
2.9%
5.8
Airoldi et al1
0.9%
4.2%
4.7
eSELECT Registry2
0.5%
4.6%
9.2