# Intensive antithrombotic therapy is necessary for long-term treatment in patients with symptomatic peripheral artery disease after acute myocardial infarction

## TL;DR

This study finds that patients with heart attacks and peripheral artery disease need long-term strong blood-thinning treatment to avoid death.

## Contribution

The study identifies that de-escalating antithrombotic therapy increases mortality risk in post-AMI patients with PAD.

## Key findings

- Patients with PAD had higher mortality at one year compared to those without PAD.
- De-escalation to clopidogrel significantly increased all-cause mortality in PAD patients.
- Intensive antithrombotic therapy is crucial for long-term outcomes in this high-risk group.

## Abstract

Patients with acute myocardial infarction (AMI) who have concomitant peripheral artery disease (PAD) represent a subgroup at high risk of subsequent ischaemic events. This post hoc analysis of PRAGUE-18, a multicenter, randomised trial comparing prasugrel versus ticagrelor in primary PCI, analysed the effect of symptomatic PAD and intensity of antithrombotic therapy on the prognosis of AMI patients treated with primary percutaneous coronary intervention (PCI). During 12-month follow-up, de-escalation from intensive antiplatelet therapy to clopidogrel was allowed with the permission of the treating physician for economic reasons. Symptomatic PAD was present in 2.9% of the study population (n = 1230). The presence of PAD did not significantly affect short-term outcome. At one year, the risk of death was higher in patients with concomitant PAD, 49 (4.1%) vs. 6(16.7%), HR 4.211 (1.803–9.830); p = 0,001. All-cause mortality significantly increased only in subgroup of patients who de-escalated to clopidogrel [6.37 (2.16–18.84), p = 0.001] as opposed to those who did not [3.02 (0.72–12.61), p = 0.13]. These findings suggest that long-term intensive antithrombotic therapy may be particularly important for post-AMI patients with concomitant symptomatic PAD and warrant further investigation.