TY - JOUR
T1 - Real-World Use of Novel P2Y12 Inhibitors in Patients with Acute Myocardial Infarction
T2 - A Treatment Paradox
AU - Beigel, Roy
AU - Iakobishvili, Zaza
AU - Shlomo, Nir
AU - Segev, Amit
AU - Witberg, Guy
AU - Zahger, Doron
AU - Atar, Shaul
AU - Alcalai, Ronny
AU - Kapeliovich, Michael
AU - Gottlieb, Shmuel
AU - Goldenberg, Ilan
AU - Asher, Elad
AU - Matetzky, Shlomi
N1 - Publisher Copyright:
© 2016 S. Karger AG, Basel.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Objective: To assess the real-world use, clinical outcomes, and adherence to novel P2Y12 inhibitors. Methods: We evaluated 1,093 consecutive acute myocardial infarction patients undergoing a percutaneous intervention. Patients were derived from a prospective, multicenter, nationwide registry and were followed for 30 days; 381 patients (35%) received clopidogrel, 468 (43%) received prasugrel, and 244 (22%) received ticagrelor. Patients treated with clopidogrel were older and more likely to suffer from chronic renal failure and stroke and/or present with non-ST-elevation myocardial infarction (NSTEMI) (p < 0.01 for all). Independent predictors of undertreatment with novel P2Y12 inhibitors included: older age (OR 0.17; 95% CI 0.1-0.27, p < 0.0001), a prior stroke (OR 0.41; 95% CI 0.2-0.68, p = 0.008), and NSTEMI (OR 0.37; 95% CI 0.26-0.54, p < 0.0001). Results: Novel P2Y12 inhibitors were associated with a lower incidence of cardiovascular events, major bleeding, and/or death (7.6 vs.11%, HR 0.67; 95% CI 0.43-1, p = 0.05). However, after a multivariate analysis this trend was not statistically significant. Patients discharged with ticagrelor versus thienopyridines demonstrated a higher rate of crossover to other P2Y12 inhibitors (11 vs. 5%, p = 0.03). Conclusions: In a real-world cohort, there was an underutilization of novel P2Y12 inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P2Y12 inhibitors at least as much as other patients.
AB - Objective: To assess the real-world use, clinical outcomes, and adherence to novel P2Y12 inhibitors. Methods: We evaluated 1,093 consecutive acute myocardial infarction patients undergoing a percutaneous intervention. Patients were derived from a prospective, multicenter, nationwide registry and were followed for 30 days; 381 patients (35%) received clopidogrel, 468 (43%) received prasugrel, and 244 (22%) received ticagrelor. Patients treated with clopidogrel were older and more likely to suffer from chronic renal failure and stroke and/or present with non-ST-elevation myocardial infarction (NSTEMI) (p < 0.01 for all). Independent predictors of undertreatment with novel P2Y12 inhibitors included: older age (OR 0.17; 95% CI 0.1-0.27, p < 0.0001), a prior stroke (OR 0.41; 95% CI 0.2-0.68, p = 0.008), and NSTEMI (OR 0.37; 95% CI 0.26-0.54, p < 0.0001). Results: Novel P2Y12 inhibitors were associated with a lower incidence of cardiovascular events, major bleeding, and/or death (7.6 vs.11%, HR 0.67; 95% CI 0.43-1, p = 0.05). However, after a multivariate analysis this trend was not statistically significant. Patients discharged with ticagrelor versus thienopyridines demonstrated a higher rate of crossover to other P2Y12 inhibitors (11 vs. 5%, p = 0.03). Conclusions: In a real-world cohort, there was an underutilization of novel P2Y12 inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P2Y12 inhibitors at least as much as other patients.
KW - Acute coronary syndrome
KW - Antiplatelet therapy
KW - PY Inhibitors
KW - Percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=84983783197&partnerID=8YFLogxK
U2 - 10.1159/000447396
DO - 10.1159/000447396
M3 - Article
C2 - 27548273
AN - SCOPUS:84983783197
SN - 0008-6312
VL - 136
SP - 21
EP - 28
JO - Cardiology
JF - Cardiology
IS - 1
ER -