title: Dual antiplatelet therapy in patients with stable coronary artery disease in modern practice: prevalence, correlates, and impact on prognosis (from the Suivi d'une cohorte de patients COROnariens stables en region NORd-Pas-de-Calais study).
abstract: BACKGROUND
  The prevalence and correlates of dual-antiplatelet therapy (DAPT) use in stable coronary artery disease (CAD) are unknown. In addition, whether prolonged DAPT may impact prognosis in stable CAD has not been studied in real-life conditions.
  
  
  METHODS
  We studied 3,691 patients included in a prospective registry on stable CAD. The patients were divided in 2 groups according to their antiplatelet therapy regimen at inclusion: patients treated with DAPT were compared with those treated with single-antiplatelet therapy (SAPT). The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke.
  
  
  RESULTS
  Altogether, 868 (24%) patients received DAPT. Factors positively associated with DAPT use were persistent angina at inclusion, body mass index, myocardial infarction since 1 to 3 years, myocardial revascularization since 1 to 3 years, multivessel CAD, prior drug-eluting stent implantation, and prior aortic or peripheral intervention. Factors negatively associated with DAPT use were age, prior coronary bypass, and left ventricular ejection fraction. The rate of the primary outcome at 2 years was similar whether patients were treated with SAPT (4.6%) or DAPT (5.5%) (P = .301). Similar rates were also observed after propensity score matching: 5.7% when treated with SAPT versus 5.5% when treated with DAPT (P = .886). The rate of bleeding was similar between groups.
  
  
  CONCLUSIONS
  Our study shows that a significant proportion of stable CAD patients are treated with DAPT in modern practice. Several correlates of DAPT were identified. Although no increase in bleeding was observed, our results do not support the prescription of prolonged DAPT.
authors.affiliation: Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Faculté de Médecine de Lille, Lille, France; INSERM UMR744, Institut Pasteur de Lille, Lille, France. Electronic address: gilles_lemesle@yahoo.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.affiliation: Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Faculté de Médecine de Lille, Lille, France; INSERM UMR744, Institut Pasteur de Lille, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.affiliation: Polyclinique du Bois, Lille, France.
authors.forename: Thibaud
authors.initials: T
authors.lastname: Meurice
authors.affiliation: Centre Hospitalier de Dunkerque, Dunkerque, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tricot
authors.affiliation: Centre Hospitalier de Boulogne sur Mer, Boulogne sur Mer, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Lallemant
authors.affiliation: Centre Hospitalier de Boulogne sur Mer, Boulogne sur Mer, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Nugue
authors.affiliation: Polyclinique du Bois, Lille, France.
authors.forename: Maxence
authors.initials: M
authors.lastname: Delomez
authors.affiliation: Centre Hospitalier de Béthune, Béthune, France.
authors.forename: Octave
authors.initials: O
authors.lastname: Equine
authors.affiliation: Hôpital Léon Schwartzenberg, Le Quesnoy, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Tondeux
authors.affiliation: Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Faculté de Médecine de Lille, Lille, France; INSERM UMR744, Institut Pasteur de Lille, Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D012042:Registries; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin