Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria

Kwan Yong Lee; Byung-Hee Hwang; Eun-Ho Choo; Sungmin Lim; Chan Jun Kim; Jin-Jin Kim; Jaeho Byeon; Ik Jun Choi; Gyu Chul Oh; Yoon Seok Choi; Ki Dong Yoo; Wook Sung Chung; Youngkeun Ahn; Myung Ho Jeong; Kiyuk Chang

doi:10.3389/fcvm.2022.1017533

Clinical benefit of long-term use of dual antiplatelet therapy for acute myocardial infarction patients with the PEGASUS-TIMI 54 criteria

Front Cardiovasc Med. 2022 Nov 17:9:1017533. doi: 10.3389/fcvm.2022.1017533. eCollection 2022.

Authors

Affiliations

¹ Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
² Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, South Korea.
³ Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.
⁴ Cardiovascular Center and Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea.
⁵ Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.

Abstract

Background: We evaluated the effectiveness of extended dual antiplatelet therapy (DAPT) usage after 2nd-generation drug elution stent implantation in acute myocardial infarction (AMI) survivors with high ischemic risk characteristics who had no major bleeding for 24 months under at least 1 year of DAPT maintenance.

Materials and methods: The primary ischemic and bleeding endpoints were the risk of mortality and the risk of BARC 3 or 5 (major) bleeding. We investigated the event rates for 2-5 years after the index procedure.

Results: Of 3382 post-AMI survivors who met the PEGASUS-TIMI 54 (PEGASUS) criteria and without major bleeding until 2 years, 2281 (67.4%) maintained DAPT over 24 months, and 1101 (32.5%) switched DAPT to a single antiplatelet agent. The >24 M DAPT group showed a lower risk of mortality than the 12-24 M DAPT group (7.2 vs. 9.2%; adjusted hazard ratio: 0.648; 95% confidence interval: 0.595-0.976; p < 0.001). The mortality risk was significantly greater as the number of PEGASUS criteria increased (p < 0.001). DAPT > 24 months was not significantly associated with a decreased risk for major bleeding in the population meeting the PEGASUS criteria (2.0 vs. 1.1%; p = 0.093). The results were consistent after propensity-score matching and inverse probability weighting to adjust for baseline differences.

Conclusion: Extended DAPT over 24 months was associated with a lower risk of mortality without increasing the risk of major bleeding among 2 years survivors after AMI who met the PEGASUS criteria and had no major bleeding events before 24 months.

Keywords: PEGASUS-TIMI 54; acute myocardial infarction; drug-eluting stents (DES); dual antiplatelet therapy (DAPT); percutaneous coronary intervention (PCI).