Prolonged dual antiplatelet therapy strategy in acute coronary syndrome patients post-standard therapy and adverse event-free: An analysis based on OPT-CAD risk score stratification

Background

The optimal antiplatelet strategy for patients with acute coronary syndrome (ACS) after the standard 12-month dual antiplatelet therapy (DAPT) is still a matter of concern. We aimed to apply the OPT-CAD score for risk stratification and to identify those who would derive benefit from prolonged DAPT beyond 12 months.

Methods

In this post hoc analysis of OPT-CAD study, 7154 patients with ACS, who completed 12-month DAPT without any adverse events, were divided into low-risk (n = 4171) and medium-to-high-risk (n = 2983) groups based on the OPT-CAD risk score. The primary endpoint was ischemic events, defined as the composite of cardiac death, myocardial infarction (MI) or stroke occurring between 12 and 24 months. The secondary endpoints included all-cause death and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding.

Results

After propensity score matching, in low-risk patients, ischemic events, all-cause death and BARC type 3 or 5 bleeding were comparable between prolonged DAPT and single antiplatelet therapy (SAPT) regimens. However, among the medium-to-high-risk patients, prolonged DAPT was associated with a reduction in ischemic events (hazard ratio [HR] 0.48, 95 % confidence intervals [CI] 0.29–0.81, P = 0.0062) and all-cause death (HR 0.44, 95 %CI 0.21–0.89, P = 0.0220) without apparently increasing the risk of BARC type 3 or 5 bleeding (HR 1.49, 95 %CI 0.25–8.92, P = 0.6622).

Conclusions

The OPT-CAD risk score demonstrated moderate ability to predict long-term ischemic events and all-cause mortality in patients with ACS who completed the standard 12-month DAPT without adverse events, and might help identify those more likely to derive benefit from prolonged DAPT.