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Dual antiplatelet therapy is under-prescribed in patients with surgically treated acute myocardial infarction

Marco Roberto, Dragana Radovanovic, Carmelo Buttà, Gregorio Tersalvi, Joël Krüll, Paul Erne, Hans Rickli, Giovanni Battista Pedrazzini & Marco Moccetti

abstract

OBJECTIVES
Despite guideline recommendations, previous reports, coming mainly from outside Europe, showed low rates of prescriptions for dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) undergoing surgical revascularization. The present study assesses this issue in the era of potent P2Y12 inhibitors in Switzerland.

METHODS
All patients with a diagnosis of AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry from January 2014 to December 2019 were screened; 9050 patients undergoing either percutaneous (8727, 96.5%) or surgical (323, 3.5%) revascularization were included in the analysis.

RESULTS
Surgically treated patients were significantly less likely to receive DAPT at discharge (56.3% vs 96.7%; P < 0.001). Even when discharged with a prescription for DAPT, those patients were significantly less likely to receive a regimen containing a new P2Y12 inhibitor (67/182 [36.8%] vs 6945/8440 [83.2%]; P < 0.001). At multivariate analysis, surgical revascularization was independently associated with a lower likelihood of receiving a prescription for DAPT at discharge (odds ratio 0.03, 95% confidence interval 0.02-0.06).

CONCLUSIONS
DAPT prescriptions for patients with AMI undergoing surgical revascularization are not in line with current guideline recommendations. Efforts are necessary to clarify the role of DAPT for secondary prevention in these patients and increase the confidence of treating physicians in guideline recommendations.

CLINICAL TRIAL REGISTRATION
Acute Myocardial Infarction in Switzerland Plus Registry; registration number at ClinicalTrials.gov: NCT01305785.
   
citation Roberto M, Radovanovic D, Buttà C, Tersalvi G, Krüll J, Erne P, Rickli H, Pedrazzini G B, Moccetti M. Dual antiplatelet therapy is under-prescribed in patients with surgically treated acute myocardial infarction. Interact Cardiovasc Thorac Surg 2021; 33:687-694.
   
type journal paper/review (English)
date of publishing 2021
journal title Interact Cardiovasc Thorac Surg (33/5)
ISSN electronic 1569-9285
pages 687-694
PubMed 34171919
DOI 10.1093/icvts/ivab159