Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term risk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study

Abstract

Objective: To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions. Methods: Patients >= 50 years with prior MI 1-3 years ago and >= 1 risk factor (age >= 65 years, diabetes, 2nd prior MI >1 yr ago, multivessel CAD, creatinine clearance 15-<60 ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904). Results: 9225 patients were enrolled (median 1.8 years) post-MI: 52% with prior ST-elevation MI, median age 67 years, 24% women, 67% Caucasian, 55% had >= 2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure >= 140/90 mm Hg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the indexMI. receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1 year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6 years); continued DAPT >1 year was highest (39%) in Asia-Pacific and lowest (12%) in Europe. Conclusions: Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for >1 year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1 year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.