Each patient undergoing interventional treatment for stenosis of the arteries that supply blood to the heart muscle must now receive dual antiplatelet therapy to prevent thrombosis in the stent implanted during the procedure. However, this therapy is associated with an increased risk of bleeding complications. The risk of both ischemic complications (stent thrombosis) and bleeding is particularly high among elderly patients, those with kidney disease, and those with chronic obstructive pulmonary disease (COPD). Therefore, studies are being conducted to evaluate the safety of shortening the duration of anticoagulant use after surgery and using a single drug (platelet inhibitor) for this purpose instead of two, as before.
The award-winning paper by Mariusz Tomaniak, MD, PhD, is the first evaluation to date of single therapy with ticagrelor (a potent P2Y12 platelet receptor antagonist) after percutaneous coronary intervention (PCI) in a special population of patients with coronary artery disease and coexisting COPD.
The author demonstrated that despite the altered platelet activity described among patients with COPD, these patients can safely benefit from this new form of pharmacotherapy. The use of single rather than dual platelet inhibitor treatment was not associated with an increase in the rate of myocardial infarction or stent thrombosis. It is worth noting, however, the lower therapeutic adherence (i.e. worse adherence to medication and irregular medication intake) observed in the group of patients with COPD. This suggests the need for careful post-hospital care and more frequent follow-up visits after PCI in patients with coronary artery disease coexisting with COPD.
Importantly, the analyses by Mariusz Tomaniak, MD, PhD, showed that the diagnosis of POCHP currently remains the strongest clinical factor affecting patient life expectancy after coronary artery surgery. The award-winning paper is cited in the international cardiology journals (including JACC: Cardiovascular Interventions, International Journal of Cardiology, and Clinical Research in Cardiology) and has contributed to the inclusion of a diagnosis of POCHP in an updated scale for predicting survival after PCI published in 2021 (the so-called clinical SYNTAX SCORE). The scale is used by physicians to identify patients requiring special monitoring after surgery.
These observations will help to further improve outcomes in this particularly high-risk group of patients who increasingly require interventional cardiac procedures.
The paper was published in the European Heart Journal Cardiovascular Pharmacotherapy.
