Trends in dual antiplatelet therapy regimens and clinical outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention with drug-eluting stents: A multicenter real-world study

Background: The patterns of dual antiplatelet therapy (DAPT) use and the associated clinical outcomes in current practice remain limited. This study evaluates DAPT regimen patterns and clinical outcomes among acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).Methods: This multicenter retrospective cohort study included ACS patients treated with PCI from January 2017 to February 2022 at five tertiary hospitals in Thailand. DAPT was categorized as nonpotent (NP-DAPT) or potent (P-DAPT). We described DAPT trends, with major adverse cardiovascular events (MACEs) and major bleeding, as primary efficacy and safety outcomes. Outcomes were assessed using inverse probability treatment weighting (IPTW) with Cox''s proportional hazards model.Results: The study included 1877 patients with ACS undergoing PCI. The mean age was 64.51 years (standard deviation 11.34), with 639 (34.04%) female patients and 1159 (61.75%) presenting ST-elevation myocardial infarction (STEMI). Of these, 924 (49.23%) received NP-DAPT, and 953 (50.77%) were prescribed P-DAPT. Crude MACE incidence was lower in the P-DAPT compared to the NP-DAPT group (6.82% vs. 10.28%). After applying IPTW and conducting Cox''s proportional hazard analysis, no significant differences in MACE were observed between groups (hazard ratio [HR]: 0.85, 95% confidence interval [CI]: 0.58-1.25,p = 0.408), nor in major bleeding (HR: 0.80, 95% CI: 0.37-1.70,p = 0.555). P-DAPT was associated with any higher bleeding risk (HR: 1.52, 95% CI: 1.13-2.03,p = 0.005).Conclusion: Standard DAPT remains predominant among Thai ACS patients, with NP-DAPT prescriptions approaching those of P-DAPT. Despite similar rates of MACE and major bleeding between the groups, P-DAPT was associated with a higher risk of any bleeding.