Intensive antithrombotic therapy is necessary for long-term treatment in patients with symptomatic peripheral artery disease after acute myocardial infarction
Jazyk angličtina Země Anglie, Velká Británie Médium electronic
Typ dokumentu časopisecké články, randomizované kontrolované studie, multicentrická studie
Grantová podpora
LX22NPO5104
European Union - Next Generation EU, National Institute for Research of Metabolic and Cardiovascular Diseases (Program EXCELES)
PubMed
41203670
PubMed Central
PMC12594987
DOI
10.1038/s41598-025-24372-2
PII: 10.1038/s41598-025-24372-2
Knihovny.cz E-zdroje
- Klíčová slova
- Acute myocardial infarction, Antiplatelet therapy, Peripheral artery disease, Prasugrel, Ticagrelor,
- MeSH
- fibrinolytika * terapeutické užití MeSH
- infarkt myokardu * komplikace farmakoterapie mortalita MeSH
- inhibitory agregace trombocytů * terapeutické užití aplikace a dávkování MeSH
- klopidogrel terapeutické užití MeSH
- koronární angioplastika MeSH
- lidé středního věku MeSH
- lidé MeSH
- onemocnění periferních arterií * farmakoterapie komplikace mortalita MeSH
- prasugrel hydrochlorid terapeutické užití aplikace a dávkování MeSH
- senioři MeSH
- ticagrelor terapeutické užití aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- fibrinolytika * MeSH
- inhibitory agregace trombocytů * MeSH
- klopidogrel MeSH
- prasugrel hydrochlorid MeSH
- ticagrelor MeSH
Patients with acute myocardial infarction (AMI) who have concomitant peripheral artery disease (PAD) represent a subgroup at high risk of subsequent ischaemic events. This post hoc analysis of PRAGUE-18, a multicenter, randomised trial comparing prasugrel versus ticagrelor in primary PCI, analysed the effect of symptomatic PAD and intensity of antithrombotic therapy on the prognosis of AMI patients treated with primary percutaneous coronary intervention (PCI). During 12-month follow-up, de-escalation from intensive antiplatelet therapy to clopidogrel was allowed with the permission of the treating physician for economic reasons. Symptomatic PAD was present in 2.9% of the study population (n = 1230). The presence of PAD did not significantly affect short-term outcome. At one year, the risk of death was higher in patients with concomitant PAD, 49 (4.1%) vs. 6(16.7%), HR 4.211 (1.803-9.830); p = 0,001. All-cause mortality significantly increased only in subgroup of patients who de-escalated to clopidogrel [6.37 (2.16-18.84), p = 0.001] as opposed to those who did not [3.02 (0.72-12.61), p = 0.13]. These findings suggest that long-term intensive antithrombotic therapy may be particularly important for post-AMI patients with concomitant symptomatic PAD and warrant further investigation.
Cardiology Center AGEL Pardubice Czech Republic
Cardiovascular Department University Hospital Ostrava Czech Republic
Dept of Cardiology Pardubice Hospital Pardubice Czech Republic
Dept of Cardiovascular Medicine 1 University Hospital Hradec Kralove Hradec Kralove Czech Republic
Institute of Biostatistics and Analysis Faculty of Medicine Masaryk University Brno Czech Republic
Zobrazit více v PubMed
Fuster, V., Badimon, L., Badimon, J. J. & Chesebro, J. H. The pathogenesis of coronary artery disease and the acute coronary syndromes. PubMed DOI
Gale, C. P. et al. Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: A multilevel and relative survival analysis for the national institute for cardiovascular outcomes research (NICOR). PubMed DOI
Pedersen, F. et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. PubMed DOI
Byrne, R. A. et al. 2023 ESC guidelines for the management of acute coronary syndromes. PubMed DOI
Wiviott, S. D. et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. PubMed DOI
Wallentin, L. et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. PubMed DOI
Steg, P. G. et al. One-year cardiovascular event rates in outpatients with atherothrombosis. PubMed DOI
Fowkes, F. G. et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. PubMed DOI
Kobo, O. et al. Impact of peripheral artery disease on prognosis after percutaneous coronary intervention: Outcomes from the multicenter prospective e-ULTIMASTER registry. PubMed DOI
Criqui, M. H. & Aboyans, V. Epidemiology of peripheral artery disease. PubMed DOI
Pinxterhuis, T. H. et al. Outcome after percutaneous coronary intervention with contemporary stents in patients with concomitant peripheral arterial disease: A patient-level pooled analysis of four randomized trials. PubMed DOI
Aboyans, V. et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: The European stroke organization (ESO)the task force for the diagnosis and treatment of peripheral arterial diseases of the European society of cardiology (ESC) and of the European society for vascular surgery (ESVS). PubMed DOI
Bonaca, M. P. et al. Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease. PubMed DOI
CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). PubMed
Patel, M. R. et al. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: Data from the PLATO Trial. PubMed DOI
Anand, S. S. et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: An international, randomised, double-blind, placebo-controlled trial. PubMed DOI
Franzone, A. et al. Prolonged vs short duration of dual antiplatelet therapy after percutaneous coronary intervention in patients with or without peripheral arterial disease: A subgroup analysis of the PRODIGY randomized clinical trial. PubMed DOI
Motovska, Z. et al. Prasugrel versus ticagrelor in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: multicenter randomized PRAGUE-18 study. PubMed DOI
Motovska, Z. et al. 1-year outcomes of patients undergoing primary angioplasty for myocardial infarction treated with prasugrel versus ticagrelor. PubMed DOI
Mehran, R. et al. Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the bleeding academic research consortium. PubMed DOI
Attar, R., Wester, A., Koul, S., Eggert, S. & Andell, P. Peripheral artery disease and outcomes in patients with acute myocardial infarction. PubMed DOI PMC
Steffel, J. et al. The COMPASS trial: Net clinical benefit of low-dose rivaroxaban plus aspirin as compared with aspirin in patients with chronic vascular disease. PubMed DOI
Angiolillo, D. J. et al. International expert consensus on switching platelet P2Y PubMed DOI
Sibbing, D. et al. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): A randomised, open-label, multicentre trial. PubMed DOI
Cuisset, T. et al. Benefit of switching dual antiplatelet therapy after acute coronary syndrome: the TOPIC (timing of platelet inhibition after acute coronary syndrome) randomized study. PubMed DOI
