Objective To describe international patterns of dual antiplatelet therapy (DAPT) duration after acute coronary syndrome (ACS), and explore its determinants and correlation with clinical events.
Methods EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients) is a prospective, international, observational study of 10 568 ACS hospital survivors enrolled in 555 centres from 20 countries across Europe and Latin America between 2010 and 2011, with telephone follow-up at quarterly intervals up to 24 months to assess treatment continuation and clinical events.
Results Of 8593 patients discharged on DAPT, 4859 (57%) remained on uninterrupted DAPT at end of follow-up. There were minor differences in rates of DAPT discontinuation according to age, gender, risk factors, therapeutic strategy or region, but major differences between countries. By study end, 555 of evaluable patients (5.7%) died, 727 (10.0%) experienced new cardiovascular (CV) events, 496 new coronary events (6.82%) and 154 (2.11%) clinically relevant bleeding (14 (6.7%) fatal). Most CV events and deaths (85%) occurred while on DAPT. DAPT interruption was associated with increased risk of CV events in the following week (HR 2.29; 95% CI 1.08 to 4.84) but not specifically with time to first coronary event or mortality.
Conclusions Despite guideline recommendations, most patients with ACS in Europe and Latin America remained on DAPT beyond 12 months, country being the most important determinant of DAPT duration. Increase in short-term CV risk was seen after switching from DAPT to less medication, as compared with continued DAPT, with no long-term effect on coronary or mortality risk.
Trial registration number NCT01171404; Results.
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Contributors All authors contributed to the design and conduct of the study, analysis of the study data, and opinions, conclusions and interpretation of the data. The lead author, HB, takes responsibility for the initial drafting and overall content of the manuscript, and all authors contributed to the manuscript at each stage of preparation, and approved the final version. Statistical analysis was performed by JG and SP.
Funding The EPICOR study was funded by AstraZeneca.
Competing interests HB has received advisory/consulting fees from Abbott, AstraZeneca, Bayer, BMS-Pfizer, Daichii-Sankyo, Eli-Lilly, Ferrer, Menarini, Novartis, Sanofi and Servier, and research grants from AstraZeneca. SP has received research funding from AstraZeneca. ND has received research grants from Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, MSD and Sanofi, and consulting or speaking fees from Amgen, AstraZeneca, Bayer, BMS, Boehringer-Ingelheim, GSK, MSD-Schering Plough, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi-Aventis, Servier and The Medicines Company. LA has received consulting and lecture fees from AstraZeneca. JM is an employee of AstraZeneca. JG has received research funding from AstraZeneca. FVdW has received consulting fees and research grants from Boehringer-Ingelheim and Merck, and consulting fees from Roche, Sanofi-Aventis, AstraZeneca and The Medicines Company.
Ethics approval Local/national ethics committees for each participating centre/country.
Provenance and peer review Not commissioned; externally peer reviewed.
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