Abstract
BACKGROUND: To investigate the effect of dual antiplatelet therapy (DAPT) guided by platelet function testing (PFT) on the prognosis of patients with acute coronary syndrome (ACS) at a high risk for ischemia and bleeding who underwent percutaneous coronary intervention (PCI). METHODS: A retrospective analysis was conducted on 1816 patients with ACS and a dual high risk who underwent PCI at a single center from March 2017 to November 2022. Patients were stratified into the guided DAPT group (n = 712) and standard DAPT group (n = 1104) according to whether the patient received PFT. All patients received oral DAPT for a duration of 12 months post-PCI. The deadline for the endpoint was within 12 months of receiving PCI. The primary endpoint was the number of net clinical adverse events (NACEs) that occurred during follow-up, including the composite endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding, as defined by the bleeding academic research consortium (BARC) (type 3 or greater). RESULTS: Compared with the standard DAPT group, the guided DAPT group exhibited a lower incidence of NACEs (4.8% vs. 8.7%; p = 0.001), MACCEs (3.9% vs. 6.7%; p = 0.017), cardiac death (0.4% vs. 1.5%; p = 0.038), and stroke (0.6% vs. 2.5%; p = 0.005) during follow-up. Cox regression analysis revealed that the incidence of NACEs (hazard ratio (HR): 0.543, 95% confidence interval (CI): 0.363-0.812; p = 0.003), MACCEs (HR: 0.570, 95% CI: 0.364-0.893; p = 0.014), cardiac death (HR: 0.249, 95% CI: 0.072-0.866; p = 0.029), and stroke (HR: 0.174, 95% CI: 0.060-0.501; p = 0.001) in the guided DAPT group was 0.543, 0.570, 0.249, and 0.174 times, respectively, that in the standard DAPT group. CONCLUSION: For patients with ACS who are at high risk in the East Asian population, the primary recommendation is to use PFT to guide DAPT within 12 months after PCI, which can reduce the incidence of NACEs, primarily by lowering the rate of MACCEs.