LOS ANGELES, CA—Five-year mortality in patients receiving prolonged dual antiplatelet therapy is marginally higher compared with switching to single antiplatelet therapy after 1 year, according to a real-world, nationwide registry study presented November 5, 2012, at the American Heart Association Scientific Sessions. The findings suggest that clopidogrel and aspirin should not be maintained beyond 1 year in high-risk patients undergoing coronary stent implantation.

FAST-MI is a French nationwide registry of patients hospitalized within 48 hours of STEMI or NSTEMI, at the end of 2005 in 223 centers representing 60% of all French institutions taking care of AMI patients.

François Schiele, MD, PhD, of the Université de Franche Comté (Besançon, France), and colleagues analyzed 1,040 patients from the registry who received DES followed by dual antiplatelet therapy out to 1 year and were alive at 3 years. Of those, 41.3% (n = 430) were still taking aspirin and clopidogrel at 3 years and 58.7% (n = 610) had stopped one drug after 1 year and received only 1 antiplatelet agent at 3 years.

Long-Term Dual Therapy May Increase Mortality Risk

Five-year mortality was 4.9% in patients still on dual therapy at 3 years and 2.8% in patients who stopped dual therapy after 1 year (P = 0.07). After adjustment for age, sex, clinical profile, medical history, in-hospital treatment and complications, discharge medications, and recurrent MI within 3 years, patients on long-term dual therapy were not at higher risk for 5-year mortality (HR 1.18; 95% CI 0.54-2.58; P = 0.67). Propensity-matched analysis also confirmed these results. 

“These findings do not support the prolongation of [dual antiplatelet therapy] with clopidogrel beyond 1 year,” Dr. Schiele concluded.

Discussing the study, Paul A. Gurbel, MD, of Sinai Hospital of Baltimore (Baltimore, MD), said that one explanation for higher mortality in patients on long-term clopidogrel and aspirin might be that physicians perceive these patients as higher risk from the outset, and automatically prescribe the therapy. “That’s why the survival curves don’t look favorable for patients on dual antiplatelet therapy,” he said. 

Study Details 

Patients in both study arms had similar profiles, averaging 63 years of age and about three-fourths male.

Source:
Schiele F. Is prolonged dual antiplatelet therapy after AMI associated with improved long-term survival? Five-year follow-up data from the French FAST-MI 2005 registry. Presented at: American Heart Association Scientific Sessions; November 5, 2012; Los Angeles, CA.

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