Secondary prevention and follow-up

Summary

The only specific treatment after coronary angioplasty is the dual antiplatelet therapy, comprising an association of aspirin and a P2Y12 receptor inhibitor (clopidogrel or prasugrel). The duration of this association depends on the type of stent used (BMS or DES), the initial clinical presentation (stable angina vs ACS), and the estimated thrombotic and bleeding risks of the patient. A reduction in the duration of DAPT to one-three months according to the type of stent (BMS or latest generation DES) can be discussed in stable coronary artery disease. Conversely, after ACS, 12 months of DAPT remains the rule, but this duration can be extended longer term depending on the patient characteristics, and exact DAPT duration should be discussed on a case-by-case basis.

After PCI, as for all patients with established coronary atherosclerosis, patients should receive “optimal medical therapy” to slow progression of atherosclerosis and to avoid atherothrombotic complications. Thus, the control of risk factors with lifestyle measures, and the use of drugs of proven efficacy in terms of prevention of atherosclerosis and its complications should be reinforced.

Female gender, older age, diabetes, renal dysfunction or need for oral anticoagulation, the site of the treated lesion and the type of procedure...