Temporal Trends in the Use of Antiplatelet Therapy in Patients With Acute Coronary Syndromes
Por:
Esteve-Pastor MA, Ruiz J, Orenes-Piñero E, Rivera-Caravaca JM, Quintana-Giner M, Véliz-Martínez A, Tello-Montoliu A, PerniasEscrig V, Sandin M, Vicente-Ibarra N, Macias M, Candela E, Carrillo N, Lozano M, Valdés M and Marín F
Publicada:
1 ene 2018
Resumen:
Background: Current clinical guidelines of acute coronary syndromes (ACS) recommend the use of potent antiplatelet therapy, prasugrel or ticagrelor, because both drugs consistently reduce cardiovascular events.
Purpose: The aim of this study was to examine temporal changes in the use of optimal antiplatelet therapy in patients with ACS.
Methods: A total of 1717 consecutive patients admitted for ACS in 3 tertiary hospitals from February 2014 to December 2015 were enrolled. We divided these 23 months into 4 semesters: period I (0-5 months), period II (6-11 months), period III (12-17 months), and period IV (17-23 months). Demographic, clinical, and treatment data were collected both at admission and at discharge.
Results: Treatment with clopidogrel remained constant throughout the periods (52%, 50%, 44%, and 50% for periods I, II, III, and IV, respectively), whereas a progressive increase in ticagrelor treatment was observed (15%, 25%, 26%, and 28%; P = .001). Indeed, new P2Y12 agents showed an increase from 47% at the first semester to 65% in patients with ST-segment elevation myocardial infarction (STEMI), and in patients younger than 75 years from 36% to 53%. However, for patients older than 75 years, diabetic, and patients with end-stage kidney disease, clopidogrel was the second most commonly used antiplatelet agent.
Conclusion: In this real-life registry of patients with ACS, we observed there is still a high rate of use of clopidogrel, despite guidelines recommendations, and our analyses also showed a trend toward the use of ticagrelor. Patients who received new antiplatelet agents were patients with STEMI, younger than 75 years, and with less comorbidities. However, the use of ticagrelor and prasugrel remains low, highlighting a therapeutic inertia with considerable gap between evidence-based clinical guidelines and daily clinical practice.
Filiaciones:
Esteve-Pastor MA:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
Ruiz J:
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
Orenes-Piñero E:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
Rivera-Caravaca JM:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
Quintana-Giner M:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
Véliz-Martínez A:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
Tello-Montoliu A:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
:
3 Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
Sandin M:
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
:
3 Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
Macias M:
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
Candela E:
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
Carrillo N:
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
Lozano M:
2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
Valdés M:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
Marín F:
1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
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