Abstract：
OBJECTIVE: The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) for patients without atrial fibrillation varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. Patients on DAPT with a high risk of gastrointestinal bleeding are also recommended to receive a proton pump inhibitor (PPI). Our aim was to audit current practice against the 2020 European Society of Cardiology (ESC) guideline recommendations.
METHODS: One hundred consecutive ACS patients treated with percutaneous coronary intervention discharged from Middlemore Hospital and without atrial fibrillation in the first quarter of 2023 were studied. ANZACS-QI ischaemic (I) and bleeding (B) risk scores were calculated, with patients categorised in four groups based on ESC recommendations-low I/low B risk, low I/high B, high I/low B and high I/high B. Guideline and clinician recommended duration of DAPT and prescription of PPI were compared.
RESULTS: All patients were planned for DAPT at discharge and 91% a PPI. Up to four out of five ACS patients could have been planned for shorter DAPT durations based on the ESC guideline recommendations. Over half of included patients (53%) had a high bleeding risk, yet 85% of these patients received 12 months of DAPT despite ESC recommendations of 1-3 months.
CONCLUSIONS: There was a divergence between clinical practice and the recommendations of the 2020 ESC guidelines. We discuss these results in relation to the updated August 2023 ESC guidelines, which have reaffirmed a 12-month duration of DAPT as the default position.
METHODS: One hundred consecutive ACS patients treated with percutaneous coronary intervention discharged from Middlemore Hospital and without atrial fibrillation in the first quarter of 2023 were studied. ANZACS-QI ischaemic (I) and bleeding (B) risk scores were calculated, with patients categorised in four groups based on ESC recommendations-low I/low B risk, low I/high B, high I/low B and high I/high B. Guideline and clinician recommended duration of DAPT and prescription of PPI were compared.
RESULTS: All patients were planned for DAPT at discharge and 91% a PPI. Up to four out of five ACS patients could have been planned for shorter DAPT durations based on the ESC guideline recommendations. Over half of included patients (53%) had a high bleeding risk, yet 85% of these patients received 12 months of DAPT despite ESC recommendations of 1-3 months.
CONCLUSIONS: There was a divergence between clinical practice and the recommendations of the 2020 ESC guidelines. We discuss these results in relation to the updated August 2023 ESC guidelines, which have reaffirmed a 12-month duration of DAPT as the default position.
摘要：
目的：对于无心房颤动的急性冠脉综合征（ACS）患者，推荐的双联抗血小板治疗（DAPT）的持续时间从1个月到1年不等，这取决于缺血和大出血风险的平衡。胃肠道出血风险高的DAPT患者也建议接受质子泵抑制剂（PPI）。我们的目标是根据2020年欧洲心脏病学会（ESC）指南建议审核当前的实践。
方法：研究了2023年第一季度从Middlemore医院出院且无房颤的100例连续接受经皮冠状动脉介入治疗的ACS患者。计算ANZACS-QI缺血（I）和出血（B）风险评分，根据ESC建议将患者分为四组-低I/低B风险，低I/高B，比较高I/低B和高I/高B指南和临床医生推荐的DAPT持续时间和PPI处方。
结果：所有患者均计划在出院时进行DAPT，91%aPPI。根据ESC指南建议，可能有多达五分之四的ACS患者计划缩短DAPT持续时间。超过一半的患者（53％）有较高的出血风险，尽管ESC建议接受1~3个月的DAPT,但仍有85%的患者接受了12个月的DAPT.
结论：临床实践与2020年ESC指南的建议之间存在差异。我们将讨论这些结果与2023年8月更新的ESC指南有关，他们重申了12个月的DAPT作为默认头寸。
方法：研究了2023年第一季度从Middlemore医院出院且无房颤的100例连续接受经皮冠状动脉介入治疗的ACS患者。计算ANZACS-QI缺血（I）和出血（B）风险评分，根据ESC建议将患者分为四组-低I/低B风险，低I/高B，比较高I/低B和高I/高B指南和临床医生推荐的DAPT持续时间和PPI处方。
结果：所有患者均计划在出院时进行DAPT，91%aPPI。根据ESC指南建议，可能有多达五分之四的ACS患者计划缩短DAPT持续时间。超过一半的患者（53％）有较高的出血风险，尽管ESC建议接受1~3个月的DAPT,但仍有85%的患者接受了12个月的DAPT.
结论：临床实践与2020年ESC指南的建议之间存在差异。我们将讨论这些结果与2023年8月更新的ESC指南有关，他们重申了12个月的DAPT作为默认头寸。
