The Dipyridamole Added to Dual Antiplatelet Therapy in Cerebral Infarction After First Acute Myocardial Infarction: A Nationwide, Case-Control Study

Abstract

Background and Purpose: No previous study has compared the impact of dipyridamole-based triple antiplatelet therapy on secondary stroke prevention and long-term outcomes to that of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) and previous stroke. This study aimed to evaluate the impact of dipyridamole added to DAPT on stroke prevention and long-term outcomes in patients with cerebral infarction after first AMI.Methods: This nationwide, case-control study included 75,789 patients with cerebral infarction after first AMI. A 1:4 propensity score matching ratio was adopted based on multiple variables. Finally, the data of 4,468 patients included in the DAPT group and 1,117 patients included in the Dipyridamole-DAPT group were analyzed. Primary outcome was overall survival. Secondary outcomes were cumulative event rate of recurrent MI or stroke, and cumulative intracerebral hemorrhage (ICH) and gastrointestinal bleeding rate.Results: Long-term survival rate was comparable between the two groups (log-rank P = 0.1117), regardless of sex analyses. However, after first year, DAPT subgroup revealed better survival over DAPT-dipyridamole subgroup (log-rank P = 0.0188). In age subgroup analysis, a lower survival rate was detected in younger patients from the Dipyridamole-DAPT group after first year (log-rank P = 0.0151), but no survival difference for older patients. No benefit of Dipyridamole-DAPT was detected for patients after AMI, regardless of the myocardial infarction type. DAPT was superior to Dipyridamole-DAPT in patients who underwent percutaneous coronary intervention (PCI) (log-rank P = 0.0153) and ST elevation myocardial infarction after first year (log-rank P = 0.0019). Dipyridamole-DAPT did not reduce cumulative event rate of recurrent MI or stroke in patients after AMI. Moreover, Dipyridamole-DAPT increased the cumulative ICH rate (log-rank P = 0.0026), but did not affect the cumulative event rate of gastrointestinal bleeding. In Cox analysis, dipyridamole did not improve long-term survival.Conclusions: This nationwide study showed that Dipyridamole-DAPT, compared with DAPT, did not improve long-term survival in patients with stroke after AMI, and was related to poor outcomes after 1 year. Dipyridamole-DAPT did not reduce recurrent rate of MI or stroke, but increased the ICH rate without impacting the incidence of gastrointestinal bleeding.

The risk of stroke after acute myocardial infarction in patients with and without atrial fibrillation: A nationwide cohort study

“…The NHIRD provides researchers with de-identified data via encryption of the identification codes to preserve patient anonymity and has been extensively used in epidemiologic studies in Taiwan. [10][11][12] Our use of the NHIRD data and the informed consent waiver was approved by the Human Research Committee of Kaohsiung Veterans General Hospital with the reference number of VGHKS15-CT12-01. All analyses were performed in accordance with the relevant guidelines and regulations.…”

Quality care in ST-segment elevation myocardial infarction

“…Before discharge, polypharmacy is not unusual in patients with STEMI, which may lead to drug nonadherence. [34][35][36][37] Nonadherence is a complex behavior and remains a challenging public health problem. Patient and caregiver education should begin early in the hospital stay.…”

The Risk of Stroke after Acute Myocardial Infarction in Patients with and without Atrial fibrillation: A Nationwide Cohort Study in Taiwan

“…The NHIRD provides researchers with deidenti ed data via encryption of the identi cation codes to preserve patient anonymity and has been extensively used in epidemiologic studies in Taiwan. [4][5][6] Our use of the NHIRD data and the informed consent wavier was approved by the Human Research Committee of Kaohsiung Veterans General Hospital and the reference number was VGHKS15-CT12-01. All methods were carried out in accordance with relevant guidelines and regulations.…”