Background 

Patients surviving a myocardial infarction (MI) are at a heightened risk for recurrent ischemic events that can be reduced with the long-term addition of a second antithrombotic drug to aspirin. However, data about real prescription of this therapy are lacking and sometimes controversial.

Methods 

We aimed to describe the incidence and the determinants of a dual antiplatelet therapy (DAPT) prolongation beyond 12 months in a cohort of consecutive patients undergoing percutaneous coronary intervention (PCI) with prior MI undergoing PCI and features of high ischemic risk intended as age more than 65 years, second MI, type 2 diabetes mellitus, multivessel coronary artery disease (MVCAD) and chronic kidney disease (CKD). We analysed patients enrolled in the prospective ‘Post-PCI’ registry that included patients treated with PCI for stable coronary artery disease (CAD) or acute coronary syndromes. At 12 months' follow-up, we collected data about DAPT prolongation in patients with prior MI and at least one of the previous features of high risk who did not experience ischemic and bleeding events during the follow-up.

Results 

Among 1113 patients included in the registry, 778 (72%) presented the inclusion criteria for the present study: 434 (66%) were more than 65 years old, 245 (37%) had a second MI, 189 (29%) diabetes mellitus, 480 (73%) MVCAD and 216 (33%) CKD. Despite a DAPT being prescribed for 1 year in 86% of the patients, it was prolonged for over 12 months in 105 (16%) of them. At multivariable analysis, only second MI and MVCAD were independent predictors of DAPT prolongation in a model including age more than 65 years, diabetes mellitus, CKD and PCI on left main/left anterior descending coronary artery. We found no significant difference in DAPT prolongation according to a DAPT-score value at least 2 or based on the physician who actually performed the follow-up (clinical cardiologist, interventional cardiologist or other).

Conclusion 

In patients with prior MI and features of high ischemic risk undergoing PCI, the rate of DAPT prolongation beyond 12 months was low; recurrent MI and MVCAD appeared as its main determinants.

中文翻译：

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既往有心肌梗死的高危患者双重抗血小板治疗延长：PCI后注册的见解

背景 

存活于心肌梗塞（MI）的患者发生复发性缺血事件的风险较高，可以通过长期向阿司匹林中添加第二种抗血栓药物来降低这种风险。但是，有关这种疗法的真正处方的数据尚缺乏，有时还存在争议。

方法 

我们的目的是描述连续经皮冠状动脉介入治疗（PCI）且先前的MI患者行PCI的连续患者队列中超过12个月的双重抗血小板治疗（DAPT）延长的发生率和决定因素，年龄大于或等于25岁的患者具有较高的缺血风险65岁，第二MI，2型糖尿病，多支冠状动脉疾病（MVCAD）和慢性肾脏病（CKD）。我们分析了前瞻性“ PCI后”登记册中登记的患者，其中包括接受过PCI治疗的稳定冠状动脉疾病（CAD）或急性冠脉综合征的患者。在12个月的随访中，我们收集了先前有MI且至少具有先前高危特征之一的患者中DAPT延长的数据 在随访期间未经历缺血和出血事件的患者。

结果 

在登记的1113位患者中，有778位（72％）提出了本研究的纳入标准：65岁以上的患者434位（66％），第二次MI的患者245位（37％），糖尿病189位（29％） 480（73％）MVCAD和216（33％）CKD。尽管DAPT在86％的患者中规定为1年，但在105名（16％）的患者中延长了12个月以上。在多变量分析中，在包括年龄超过65岁，糖尿病，左冠状动脉/左前降支的CKD和PCI的模型中，仅第二MI和MVCAD是DAPT延长的独立预测因子。根据DAPT评分，我们发现DAPT延长没有明显差异 值至少为2或基于实际进行随访的医师（临床心脏病专家，介入心脏病专家或其他）。

结论 

在有心梗且有较高缺血风险的PCI患者中，超过12个月的DAPT延长率很低。复发性MI和MVCAD似乎是其主要决定因素。