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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1017533

DOI=10.3389/fcvm.2022.1017533

ISSN=2297-055X

ABSTRACT=Background: The optimal duration of dual antiplatelet therapy (DAPT) after 1 year of maintenance for acute myocardial (AMI) patients is not well known. We evaluated the effectiveness of extended DAPT usage after 2nd-generation drug elution stent implantation in AMI survivors who had no severe bleeding for 24 months.
Methods: The primary ischemic endpoint was the risk of mortality, and the primary bleeding endpoint was the risk of BARC 3 or 5 (major) bleeding. We investigated the event rates 2 to 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 to 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.
Conclusions: Extended DAPT over 24 months was associated with a lower risk of mortality without increasing the risk of major bleeding among two-year survivors after AMI who met the PEGASUS criteria and had no major bleeding events before 24 months.