SAFETY AND EFFICACY OF DUAL ANTIPLATELET THERAPY IN PAKISTANI PATIENTS UNDERGOING PCI: A MULTICENTER STUDY

Abstract

Percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease (CAD), particularly in patients with acute coronary syndromes. Dual antiplatelet therapy (DAPT), which includes aspirin and a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel, is the standard post-PCI treatment to prevent thrombotic complications. Despite the benefits of DAPT, its safety and efficacy in the Pakistani population, which has a high prevalence of CAD, are not well-documented. Objective: This study aimed to evaluate the safety and efficacy of DAPT in Pakistani patients undergoing PCI by measuring the incidence of stent thrombosis, bleeding complications, and major adverse cardiac events (MACE) over a 12-month follow-up period. Methods: This prospective observational study was conducted from January 2022 to December 2023 across three centers: Lady Reading Hospital Peshawar, Mardan Medical Complex, and Hayatabad Medical Complex. The study included 300 adult patients scheduled for PCI. Participants received DAPT, consisting of aspirin and a P2Y12 inhibitor, before PCI and continued for at least 12 months post-procedure. Primary outcomes were the incidence of stent thrombosis, bleeding complications, and MACE. Secondary outcomes included improved left ventricular ejection fraction (LVEF), exercise tolerance, and angina symptoms. Data were analyzed using SPSS version 26.0. Results: The mean age of participants was 60 ± 10 years, with 65% male. The overall incidence of stent thrombosis was 3%, bleeding complications occurred 8%, and MACE was observed in 15% of patients. LVEF improved from 42% ± 8% pre-procedure to 50% ± 7% post-procedure (p < 0.001). The six-minute walk test distance increased from 320 ± 55 meters pre-procedure to 370 ± 50 meters post-procedure (p < 0.01). The frequency of angina episodes decreased from 4.2 ± 1.5 to 1.7 ± 0.9 per week (p < 0.001). Conclusion: DAPT significantly improves clinical outcomes in Pakistani patients undergoing PCI, enhancing LVEF and exercise tolerance and reducing angina episodes. However, the risk of bleeding complications necessitates careful patient management. These findings support the continued use of DAPT in this population, emphasizing the need for individualized treatment plans and continuous monitoring.