title: Impact of prolonged dual antiplatelet therapy after acute myocardial infarction on 5-year mortality in the FAST-MI 2005 registry.
abstract: BACKGROUND
  We document dual antiplatelet therapy (DAPT) use from discharge to 4 years after acute myocardial infarction (AMI), and investigate whether prolonged DAPT (beyond 1 year) is related to 5-year mortality.
  
  
  METHODS
  The French Registry of Acute ST-elevation or non-ST-elevation Myocardial Infarction (FAST-MI 2005) included 3670 patients with AMI in 223 French centres. We identified predictors of DAPT (aspirin+clopidogrel) beyond 1 and 2 years, and relation with all-cause 5-year mortality.
  
  
  RESULTS
  Among 3319 (96%) patients with discharge data, 2432 (73%) had DAPT, 582 (17%) single antiplatelet therapy (SAPT), and 305 (9%) no antiplatelet treatment. DAPT decreased from 75% at 1 year to 29% at 4 years, with a corresponding increase in SAPT (p<0.05 for trend). Patients with DAPT were more often male, treated with a drug-eluting stent (DES), and without oral anticoagulants. Independent predictors at 1 year of prolonged DAPT were age<75 years, in-hospital bleeding, history of MI, use of DES, discharge use of beta-blockers or statins and no chronic anticoagulation. Predictors at 2 years were age<75 years, male gender, previous MI, diabetes, DES implantation, no chronic oral anticoagulation. By multivariate analysis, there was no difference in 5-year mortality between those on SAPT vs DAPT at 1 year. DAPT at 2 years was also not significantly related to 5-year mortality (Hazard Ratio 1.3, 95% CI [0.9; 1.8], p=0.21).
  
  
  CONCLUSIONS
  Prolonged DAPT in selected AMI patients, observed in 47% at 1 year and 21% at 2 years, had no impact on 5-year mortality. These findings do not support the use of DAPT beyond 1 year after an initial ACS.
authors.affiliation: University Hospital Jean Minjoz, EA3920, Besançon, France. Electronic address: francois.schiele@Univ-fcomte.fr.
authors.forename: Francois
authors.initials: F
authors.lastname: Schiele
authors.affiliation: Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: Hôpital Nord, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
authors.affiliation: Clinique de Fontaine, Fontaine-lès-Dijon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dentan
authors.affiliation: University Hospital Jean Minjoz, EA3920, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.affiliation: Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: University Hospital Gabriel Montpied, Clermont Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.affiliation: Centre Hospitalier Général, Vichy, France.
authors.forename: Ramin
authors.initials: R
authors.lastname: Ravan
authors.affiliation: Hôpital Arnaud de Villeneuve, Montpellier, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.affiliation: Clinique mutualiste des Eaux claires, Grenoble, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: APHP-Hôpital Saint Antoine, Paris, France; INSERM U-698, UPMC, Paris 06, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Berard
authors.affiliation: APHP-Hôpital Saint Antoine, Paris, France; INSERM U-698, UPMC, Paris 06, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D012042:Registries; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Antiplatelet therapy; Aspirin; Clopidogrel; Mortality