Gender differences with short-term vs 12 months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-years follow-up results of the REDUCE trial.

BACKGROUND: Gender differences in the thrombotic and bleeding risk have been suggested to condition the benefits of antithrombotic therapies in Acute Coronary Syndrome (ACS) patients, and mainly among those undergoing percutaneous coronary interventions with drug eluting stents (DES). The impact of gender on the optimal duration of dual antiplatelet therapy (DAPT) in ACS patients is still unexplored and was, therefore, the aim of the present sub-study. METHODS: REDUCE was a prospective, multicenter, randomized investigator-initiated study designed to enroll 1500 ACS patients after treatment with the COMBO Dual Stent Therapy, based on a noninferiority design. Patients were randomized in a 1:1 fashion to either 3 or 12 months of DAPT. Primary study endpoint was a composite of all-cause mortality, myocardial infarction, definite/probable stent thrombosis (ST), stroke, target-vessel revascularization (TVR) and bleedings (BARC II, III, V) at 12 months. Secondary endpoints were cardiovascular mortality and the individual components of the primary endpoint within 24 months. RESULTS: From June 2014 to May 2016 300 women and 1196 men were included in the study. Among them, 43.7% of females and 51.9% of males were assigned to the 3 months DAPT treatment. Baseline characteristics were well matched between the two arms, with the exception of a lower rate of TIMI flow < 3 (p = 0.04), lower systolic blood pressure (p = 0.05) and use of spironolactone (p = 0.006) among women and a more advanced age (p = 0.05) among men receiving a short-term DAPT. At a mean follow-up of 525 (± 198) days, no difference in the primary endpoint was observed according to DAPT duration in both females [6.9% vs 5.9%, HR (95% CI) = 1.19 (0.48-2.9), p = 0.71] and males [8.2% vs 9%, HR (95% CI) = 0.92 (0.63-1.35), p = 0.67; p INT = 0.20]. Results were confirmed after correction for baseline differences [females: adjusted HR (95% CI) = 1.12 (0.45-2.78), p = 0.81; males: adjusted HR (95% CI) = 0.90 (0.61-1.32), p = 0.60]. Comparable rates of survival, thrombotic (MI, stent thrombosis, TVR, stroke) and bleeding events were observed with the two DAPT strategies, with no impact of gender. CONCLUSIONS: The present study shows that among ACS patients randomized in the REDUCE trial, a 3 months DAPT strategy offers comparable results as compared to a standard 12 months DAPT at 2-years follow-up in both male and female gender.

Differences in physician attitudes towards patient-centredness: across four medical specialties.

AIMS: There is limited study on patient-centred attitudes with regards to the patient-physician relationship in physicians. The objective of this study was to examine and compare physician attitudes toward patient-centredness in four different medical settings. METHODS: The present study utilised a cross-sectional survey design and purposive sampling to recruit physicians from a single academic medical centre via face-to-face interviews. Patient-centred attitudes of physicians specialising in surgery, oncology, obstetrics and gynaecology and primary care (N = 78) were compared on the Patient-Practitioner Orientation Scale (PPOS) using an independent one-way analysis of variance (ANOVA). The four medical specialties comprised the four levels, with role orientation (patient-centred orientation vs. doctor-centred orientation) as the dependent measure. RESULTS: A significant level of difference (p < 0.001) was found between the four specialisations: oncologists were found to have the highest level of patient-centeredness, followed by obstetricians & gynaecologists and primary care physicians, with surgeons being the least patient-centred among specialisations sampled. CONCLUSION: These data are the first from the South-East Asian region to demonstrate differences in physician attitudes between medical specialties. Our findings prompt further investigation and confirmation as to whether physicians with particular attitudinal traits are attracted to any particular specialties of medicine, or if physician attitudes are acquired through professional experience and training. In addition, this study offers better insight into the attitudinal differences of physician between medical specialities.

Malaysia-ACute CORonary syndromes Descriptive study (ACCORD): evaluation of compliance with existing guidelines in patients with acute coronary syndrome.

INTRODUCTION: The ACute CORonary syndromes Descriptive study (ACCORD) is a prospective observational study that evaluates the management of acute coronary syndrome (ACS) in clinical practice and the use of antiplatelet agents in acute settings and after discharge. The secondary objective of this study was to obtain information on risk factors in a large cohort of patients with ACS. METHODS: The study population included subjects aged at least 21 years who had unstable angina or non-ST elevation myocardial infarction. The patients had four follow-up visits over a one-year period. RESULTS: A total of 525 patients from Malaysia were enrolled into the study. The mean age of the patients was 58.14 +/- 11.3 years, and the mean body mass index was 25.4 +/- 4.3 kg/m2. 96.8 percent of subjects had at least one cardiovascular risk factor. Following hospitalisation, 83.6 percent of patients were managed medically. During the follow-up visits, 62.7-77.6 percent of patients received aspirin only, 5.0-6.8 percent received clopidogrel only and 15.6-32.3 percent received dual antiplatelet medications. Compliance with aspirin was 93.5-96.5 percent. Clopidogrel compliance was above 80 percent of the prescribed tablets for more than 88 percent of patients. CONCLUSION: Patients in the Malaysia-ACCORD registry were much younger compared to those in the Global Registry of Acute Coronary Events. The majority of patients had cardiovascular risk factors at presentation and were treated medically, and those on dual antiplatelet therapy had a relatively high level of compliance.