Dual antiplatelets therapy prescription trends and mortality outcomes among senior citizens with acute coronary syndro-me:insights from the Malaysian National Cardiovascular Dise-ase Database
Siti Zaleha Suki1
Ahmad Syadi Mahmood Zuhdi2
Abqariyah Yahya3
Nur Lisa Zaharan4
1.Department of Pharmacology,Universiti Malaya,Kuala Lumpur,Malaysia;Centre of Preclinical Science Studies(Ph-armacology),Faculty of Dentistry,Universiti Teknologi MARA,Selangor,Malaysia2.Cardiology Unit,Department of Medicine,Universiti Malaya,Kuala Lumpur,Malaysia3.Department of Social and Preventive Medicine,Universiti Ma-laya,Kuala Lumpur,Malaysia4.Department of Pharmacology,Universiti Malaya,Kuala Lumpur,Malaysia
摘要：OBJECTIVES To examine 5-year trends and variations in dual antiplatelet therapy(DAPT)prescription among multiethnic Ma-laysian patients aged 60 years and older.
METHODS Using the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome(NCVD-ACS)registry,DAPT 5-year temporal trends prescribing patterns at discharge were examined.Multivariate logistic regression was used to calculate the ad-justed odds ratio(aOR)of DAPT prescription.The 1-year all-cause mortality by Cox proportional hazard regression model(adjus-ted hazard ratio,aHR)using inverse proportional weighting covariates adjustment was performed to assess DAPT prognostic im-pacts.
RESULTS Data of patients aged 60 years and older were extracted from 2013 to 2017(n=3718,mean age:68±6.74 years,men:72％,and Malay ethnicity:43％).The majority of patients were diagnosed with non-ST-segment elevation acute coronary syndro-me(63％),predisposed hypertension(76％)and were overweight(74％),while only 35％of patients underwent percutaneous coro-nary intervention.Over the five years,there was a significant increasing trend in DAPT prescriptions(P＜0.001),with the aspirin-clopidogrel combination being the most common.Aspirin-ticagrelor prescriptions have also increased over the years.Variations in DAPT prescriptions were observed based on patient characteristics.Patients who underwent percutaneous coronary intervention were more likely to be prescribed DAPT in general(aOR=2.53,95％CI:1.95-3.28,P＜0.001)and aspirin-ticagrelor specifically(aOR=7.76,95％CI:5.65-10.68,P＜0.001).Patients with chronic lung disease(aOR=0.62,95％CI:0.42-0.92,P=0.02)and a history of ang-ina within two weeks(aOR=0.69,95％CI:0.56-0.85,P＜0.001)were approximately 30％less likely to be prescribed DAPT.Appr-oximately 15％of 1-year all-cause mortality were reported.Older patients prescribed DAPT showed significantly higher survival ra-tes than those who were not(aHR＜1.0,P＜0.001).Aspirin-ticagrelor was associated with higher survival rates than aspirin-clop-idogrel(aHR=0.21,95％CI:0.11-0.40,P＜0.001).
CONCLUSIONS Despite the optimal prescription rate and variation of DAPT in the older Malaysian population,there is room for investigation and improvement in the prescription of newer DAPT combinations that have been suggested to improve patient survival.
机标关键词：insightsnationaldatabasewithfromdualacuteamong
论文发表日期：2025-02-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：9( 237-245 )