Affiliations 

  • 1 Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany. Florian.Krackhardt@charite.de
  • 2 Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany
  • 3 University Hospital Královské Vinohrady, Prague, Czech Republic
  • 4 IKEM, Prague, Czech Republic
  • 5 SÚSCCH, a.s. Banská Bystrica, Slovak Republic
  • 6 Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
  • 7 Hospital Universitario de Cruces, Bilbao, Spain
  • 8 Hospital Universitari Vall d'Hebron Barcelona, Barcelona, Spain
  • 9 Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  • 10 Pantai Ayer Keroh Hospital, Malacca, MLK, Malaysia
  • 11 Gachon University Gil Medical Center, Incheon, South Korea
  • 12 Chonnam National University, Gwangju, South Korea
  • 13 Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
  • 14 Clinical Hospital Center Rijeka, Rijeka, Croatia
  • 15 Clinique du Millénaire, Montpellier, France
  • 16 Clinique Turin Paris, Paris, France
  • 17 Hôpital Albert Schweitzer Colmar, Colmar, France
  • 18 Centre Hospitalier d'Avignon, Avignon, France
Cardiovasc Drugs Ther, 2020 06;34(3):335-344.
PMID: 32212061 DOI: 10.1007/s10557-020-06963-5

Abstract

OBJECTIVES: The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population.

METHODS: Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel.

RESULTS: For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.