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DAPT Duration

Abstract

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Dual Antiplatelet Therapy Duration in Medically Managed Acute Coronary Syndrome Patients: Sub-Analysis of the OPT-CAD Study Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome: The TICO Randomized Clinical Trial Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): a randomised trial The optimal duration of dual antiplatelet therapy after coronary stent implantation: to go too far is as bad as to fall short Safety and efficacy of the bioabsorbable polymer everolimus-eluting stent versus durable polymer drug-eluting stents in high-risk patients undergoing PCI: TWILIGHT-SYNERGY Trial Design Principles for Patients at High Bleeding Risk Undergoing PCI: JACC Scientific Expert Panel
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Original Research2018 Jun 12;137(24):2551-2553.

JOURNAL： Article Link

Conceptual Framework for Addressing Residual Atherosclerotic Cardiovascular Disease Risk in the Era of Precision Medicine

Patel KV, Pandey A, de Lemos JA et al. Keywords: atherosclerosis; biomarkers; precision medicine; residual risk; secondary prevention

ABSTRACT

Until recently, therapies to mitigate atherosclerotic cardiovascular disease (ASCVD) risk have been limited to lifestyle interventions, blood pressure-lowering medications, high-intensity statin therapy, antiplatelet agents, and, in select patients, coronary artery revascularization. Despite administration of these evidence-based therapies, substantial residual risk for cardiovascular events persists, particularly among individuals with known ASCVD. Moreover, the current guideline-based approach does not adequately account for patient-specific, causal pathways that lead to ASCVD progression and complications. In the past few years, multiple new pharmacological agents, targeting conceptually distinct pathophysiological targets, have been shown in large and well-conducted clinical trials to lower cardiovascular risk among patients with established ASCVD receiving guideline-directed medical care. These evidenced-based therapies reduce event rates and, in some cases, all-cause and cardiovascular mortality; these benefits confirm important new disease targets and challenge the adequacy of the current standard of care for secondary prevention.

After years of treating our patients after an acute coronary syndrome event with the same core group of medications that have been proven to be safe, beneficial, and cost-effective, a diverse array of potentially beneficial options to address residual risk is now available. The near simultaneous development of these new approaches to secondary prevention disrupts existing paradigms regarding assessment and treatment of residual risk. For example, consider a hypothetical patient with obesity, hypertension, type 2 diabetes mellitus, and hyperlipidemia who had a non-ST elevation myocardial infarction and received an intracoronary drug-eluting stent. This patient would likely be …

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