ABSTRACT
Dual antiplatelet therapy (DAPT) remains the gold standard in patients undergoing percutaneous coronary intervention (PCI). The aim of this meta-analysis is to evaluate the clinical safety of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor, after PCI with drug eluting stents (DES). PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 5 RCTs with 29,831 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary endpoint was major bleeding and co-primary endpoint stent thrombosis. The secondary endpoint included all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke and major adverse cardiovascular or cerebrovascular events (MACCE). Compared to >1-month DAPT, the 1-month DAPT was associated with lower rate of major bleeding (OR=0.66, 95%CI: 0.45 to 0.97, p=0.03, I2=71%), whereas stent thrombosis had similar rate in both study groups (OR=1.08, 95%CI: 0.81 to 1.44, p=0.60, I2=0.0%). The study groups had similar risk for all-cause mortality (OR=0.89, 95%CI: 0.77 to 1.04, p=0.14, I2=0.0%), CV death (OR=0.84, 95%CI: 0.59 to 1.19, p=0.32, I2=0.0%), MI (OR=1.04, 95%CI: 0.89 to 1.21, p=0.62, I2=0.0%) and stroke (OR=0.82, 95%CI: 0.64 to 1.05, p=0.11, I2=6%). The risk of MACCE was lower (OR=0.86, 95%CI: 0.76 to 0.97, p=0.02, I2=25%) in the 1-month DAPT compared to >1-month DAPT. In conclusion, in patients undergoing PCI with DES, 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor reduce major bleeding with no risk of increased thrombotic risk compared to longer term DAPT.
ABSTRACT
BACKGROUND: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. AIM: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. METHODS: This was a cross-sectional study conducted at the University Clinical Center of Kosovo, which included all patients hospitalized with acute MI over a period of 7 years. RESULTS: Among the 7353 patients admitted with acute MI (age 63 ± 12 years, 29% female), 59.4% had STEMI and 40.6% had NSTEMI. The patients with NSTEMI patients less (48.3% vs. 54%, p < 0.001), but more of them had diabetes (37.8% vs. 33.6%, p < 0.001), hypertension (69.6% vs. 63%, p < 0.001), frequently had a family history of coronary artery disease (CAD) (40% vs. 38%, p = 0.009), and had more females compared to the patients with STEMI (32% vs. 27%, p < 0.001). The patients with NSTEMI underwent less primary percutaneous interventions compared with the patients with STEMI (43.6% vs. 55.2%, p < 0.001). Smoking [1.277 (1.117-1.459), p Ë 0.001] and high triglycerides [0.791 (0.714-0.878), p = 0.02] were independent predictors of STEMI. CONCLUSIONS: In Kosovo, patients with STEMI are more common than those with NSTEMI, and they were mostly males and more likely to have diabetes, hypertension, and a family history of CAD compared to those with NSTEMI. Smoking and high triglycerides proved to be the strongest predictors of acute STEMI in Kosovo, thus highlighting the urgent need for optimum atherosclerosis risk control and education strategies.
