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Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study.

ABSTRACT: BACKGROUND:Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real-world AMPs up to 2?years post discharge for ACS. HYPOTHESIS:There is wide variability in AMP use for ACS management in Asia. METHODS:EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2?years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ?12?months post discharge compared with >12?months. RESULTS:Data were available for 12?922 patients; of 11?639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ?12?months and 9275 (79.7%) for >12?months, with approximately 60% still on DAPT at 2?years. Patients who received DAPT for >12?months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow-up were lower in patients with DAPT >12 vs ?12?months, but no causal association can be implied in this non-randomized study. CONCLUSIONS:Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2?years post discharge. Patients not on DAPT at 12?months are a higher risk group requiring careful monitoring.

SUBMITTER: Zheng B

PROVIDER: S-EPMC7462192 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study.

Zheng Bo B Huo Yong Y Lee Stephen W-L SW Sawhney Jitendra P S JPS Kim Hyo-Soo HS Krittayaphong Rungroj R Pocock Stuart J SJ Nhan Vo T VT Alonso Garcia Angeles A Chin Chee Tang CT Jiang Jie J Jan Stephen S Vega Ana Maria AM Hayashi Nobuya N Ong Tiong K TK

Clinical cardiology 20200702 9

<h4>Background</h4>Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real-world AMPs up to 2 years post discharge for ACS.<h4>Hypothesis</h4>There is wide variability in AMP use for ACS management in Asia.<h4>Methods</h4>EPICOR Asia (NCT01361386) is a prospecti ...[more]

PMID: 32618009

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Project description:BackgroundAcute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study.MethodsEPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns.ResultsEPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients.ConclusionThis study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI.

Dataset Information

Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study.

Publications

Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study.

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