CC BY 4.0 · TH Open 2018; 02(04): e437-e444
DOI: 10.1055/s-0038-1676529
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study

Luca Degli Esposti
1   CliCon S.r.l., Health, Economics, and Outcomes Research, Ravenna, Italy
Valentina Perrone
1   CliCon S.r.l., Health, Economics, and Outcomes Research, Ravenna, Italy
Chiara Veronesi
1   CliCon S.r.l., Health, Economics, and Outcomes Research, Ravenna, Italy
Stefano Buda
1   CliCon S.r.l., Health, Economics, and Outcomes Research, Ravenna, Italy
Roberta Rossini
2   USC Cardiologia, Ospedale Santa Croce e Carle, Cuneo, Italy
on Behalf of a LHUs Group › Author Affiliations
Further Information

Publication History

26 January 2018

25 October 2018

Publication Date:
21 December 2018 (online)


The aim of this study was to assess long-term drug adherence and prognosis in real-world patients discharged on dual-antiplatelet therapy (DAPT) after acute myocardial infarction (AMI). A retrospective cohort analysis using administrative databases kept by eight local health units was performed. DAPT exposure (defined as ≥ 2 prescriptions), adherence, and the occurrence of major adverse events (MACE) were analyzed during a 36-month follow-up. The analysis included 11,101 patients who were discharged alive with a primary diagnosis of AMI. Of these, 5,919 patients (53.31%) were discharged on DAPT without a diagnosis of cancer or anemia, without transient DAPT discontinuation, and represented the study population. DAPT discontinuation occurred in 2,200 patients (37.2%) and in 1,995 (33.7%) after the first 6 and 12 months, respectively, whereas 423 patients (7.1%) were still on DAPT after 36 months. Patients who maintained DAPT up to 12 months had a significantly lower overall mortality, compared with patients who discontinued DAPT after 6 months. Exposure to DAPT at 3 years was associated with reduced all-cause mortality (hazard ratio [HR]: 0.067, 95% confidence interval [CI]: 0.027–0.162, p < 0.001) and reduced recurrent AMI (HR: 0.02, 95% CI: 0.003–0.173, p < 0.001). In conclusion, this study shows that prolonged DAPT over 12 months is maintained in a relevant number of patients after AMI. However, adherence to antiplatelet therapy in first 12 months after AMI is still unsatisfactory and efforts to enhance patients' compliance are warranted. Exposure to prolonged DAPT at 3 years seems to be associated with a significant reduction in all-cause mortality and AMI.

Authors' Contributions

All authors contributed toward data analysis, drafting, and revising the manuscript and agree to be accountable for all aspects of the work.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent is not required by the Local Health Unit (LHU) ethics committees for using encrypted retrospective information. No identifiers related to patients were provided to the researchers. This study was notified to the local ethics committee in each participating LHU according to the Italian law regarding the conduct of observational analysis, and the LHU Ethics Committees approved the study.

* LHU group: Samanta Sonzogni, Rossana Piccinelli e Marco Gambera (LHU Bergamo); Isabella Ruggeri (LHU Milano 2); Giovanna Riccioni (LHU Roma 1); Fabrizio Quarta (LHU Lecce).

Supplementary Material