Abstract 250: Antiplatelet Therapy in Post-Acute Coronary Syndrome: Effect of Education on Physician Knowledge and Competence

Author(s):  
Thomas O’Neil ◽  
Philippe Guedj ◽  
Suzanne Hughes

Background: Decreasing hospital readmission rates resulting from suboptimal antiplatelet therapy requires education to diminish an gap in physician knowledge/competence. We sought to determine if online medical education could improve clinical knowledge/competence regarding dual antiplatelet therapy (DAPT) in post-acute coronary syndrome (ACS) patients among non-United States (US) cardiologists. Methods: The educational activity was a 30-minute online video discussion between 4 experts with synchronized slides. Educational effect was assessed using a 4-question repeated pairs pre-/post-assessment and McNemar’s chi-squared test. P values are shown as a measure of significance; P values <.05 are statistically significant. Cramer’s V statistic indicated the effect size (<0.05 no effect; 0.06-0.15 small effect, 0.16-0.30 medium effect, >0.30 large effect). The activity launched August 23, 2016; data were collected through December 20, 2016. Results: 117 non-US cardiologists completed the study. The change in correct responses from pre- to post-assessment achieved statistical significance (P<.05) for 2 of 3 questions. An average of 26% of cardiologists selected the best response at pre-assessment (range, 9% to 38%); this figure improved to an average of 35% at post-assessment (range, 22% to 55%). Specific improvements were observed in the following areas: The relationship between platelet reactivity and stent thrombosis with DAPT post-drug eluting stent implantation (90% improvement, 29%pre vs 55%post, P = <.001) Optimal treatment strategy with adenosine diphosphate platelet receptor (P2Y12) inhibition in patients with unstable angina or non-ST segment myocardial infarction (144% improvement, 9%pre vs 22%post, P =.007) Conclusion: Participation in a 30-minute online video discussion with synchronized slides resulted in statistically significant improvement in non-US cardiologists’ knowledge and competence regarding DAPT in patients with post-ACS.

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
R Zhang ◽  
ZX Cai ◽  
KF Dou

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the benefits and risks of extended-term (&gt;12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identified from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT &gt; 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction &gt; 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.


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