![]() ![]() Both studies showed a reduction in ischemic events but at the cost of increased bleeding. The DAPT Study (The Dual Antiplatelet Therapy Study) and the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of AspirinThrombolysis in Myocardial Infarction 54) trial evaluated the use of prolonged DAPT (30 months in DAPT and 33 months in PEGASUS-TIMI 54) in patients receiving drug-eluting coronary stents. 10īalancing the risks and benefits and duration of DAPT after percutaneous coronary intervention (PCI) is an ongoing debate in the cardiology community. 9 However, longer duration dual antiplatelet therapy (DAPT) was associated with increased risk of bleeding. 8 A sub-study of the CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance) trial, which included patients with prior MI, prior ischemic stroke, or symptomatic PAD, reported a 1.5% absolute risk reduction in the composite of MI, cardiovascular death, and stroke over a 27-month follow-up in patients treated with aspirin and clopidogrel versus aspirin alone. 7 In patients who experienced a recent ischemic event (ischemic stroke, myocardial infarction, or symptomatic PAD), the CAPRIE (Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events) trial established the slight benefit of long-term clopidogrel over aspirin in reducing the composite of ischemic stroke, MI, or death. 5,6Īntiplatelet therapy has been shown to reduce major adverse cardiovascular events (MACE) in patients with PAD. 4 The association of underlying polyvascular disease with worse outcomes after acute coronary events has been shown to persist out to 3 years, partially due to lower rates of appropriate coronary revascularization in this population. ![]() 3 In patients with acute coronary syndromes, presence of PAD at baseline is associated with higher in-hospital (7.2 vs. 12.1% in patients with at least one prior ischemic event). 10.3% in stable atherosclerosis and 17.7 vs. 2,3 For example, 4-year data from the REACH (Reduction of Atherothrombosis for Continued Health) registry reported higher mortality in patients with polyvascular atherosclerotic disease versus disease of a single vascular bed (15.4 vs. Atherosclerosis of multiple vascular beds portends worse intermediate and long-term prognoses. 1 The known risk factors for the development of atherosclerosis (ageing, diabetes, smoking, hypertension, obesity, and dyslipidemia) affect disease progression in all of these vascular beds. Data from the AGATHA (A Global Atherothrombosis Assessment) registry reported that one in three patients with CAD had coexistent cerebrovascular disease and one in five had coexistent PAD. It is not uncommon to encounter patients with acute coronary syndromes and coronary artery disease (CAD) who have preexisting peripheral arterial disease (PAD). ![]()
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