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Eur Heart J Cardiovasc Pharmacother. 2016 Jul;2(3):152-67. doi: 10.1093/ehjcvp/pvw003. Epub 2016 Jan 27.

Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries.

Author information

1
Department of Cardiology, Hospital Europeen Georges Pompidou, AP-HP, Paris, France Université Paris Descartes, Paris, France nicolasdanchin@yahoo.fr.
2
Cardiology Unit Humanitas Research Hospital, Rozzano (Milano), Italy.
3
Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany.
4
Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
5
Cardiology Service, Hospital Universitari de Tarragona Joan XXIII, IISPV Tarragona, Spain.
6
Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
7
Heart Disease Institute Bellvitge University Hospital IDIBELL, University of Barcelona, Barcelona, Spain.
8
Department of Cardiology, University Hospital Antwerp, Edegem, Belgium.
9
Department of Cardiovascular Sciences, Laboratory of Interventional Cardiology European Hospital, Rome, Italy.
10
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
11
Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
12
AMIS-Plus Data Center University of Zurich, Zurich, Switzerland.
13
Pôle de l'urgence, Service de SAMU du Nord, Centre Hospitalier régional Universitaire de Lille, Lille, France.
14
Department of Cardiology, Skåne University Hospital, Lund, Sweden.
15
Cardiac Intensive Care Unit, Interventional Cardiology Hopital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
16
Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
17
Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France.
18
AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
19
Cardiology Department Hospital La Paz, IdiPaz, Madrid, Spain.
20
2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria.
21
Swansea University, College of Medicine, Swansea, Wales, UK.
22
Cardiology Freeman Hospital and Institute of Cellular Medicine, Newcastle Upon Tyne, UK.
23
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

AIMS:

Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in patients with STEMI based on the data from contemporary European ACS registries.

METHODS AND RESULTS:

Twelve registries provided data in a systematic manner on outcomes in STEMI patients overall, and seven of these also provided data for P2Y12 receptor inhibitor-based dual antiplatelet therapy. The registries were heterogeneous in terms of site, patient, and treatment selection, as well as in definition of endpoints (e.g. bleeding events). All-cause death rates based on the data from 84 299 patients (9612 patients on prasugrel, 11 492 on ticagrelor, and 27 824 on clopidogrel) ranged between 0.49 and 6.68% in-hospital, between 3.07 and 7.95% at 30 days (reported in 6 registries), between 8.15 and 9.13% at 180 days, and between 2.41 and 9.58% at 1 year (5 registries). Major bleeding rates were 0.09-3.55% in-hospital (8 registries), 0.09-1.65% at 30 days, and 1.96% at 1 year (only 1 registry). Fatal/life-threatening bleeding was rare occurring between 0.08 and 0.13% in-hospital (4 registries) and 1.96% at 1 year (1 registry).

CONCLUSIONS:

Real-world evidence from European contemporary registries shows that death, ischaemic events, and bleeding rates are lower than those reported in Phase III studies of P2Y12 inhibitors. Regarding individual P2Y12 inhibitors, patients on prasugrel, and, to a lesser degree, ticagrelor, had fewer ischaemic and bleeding events at all time points than clopidogrel-treated patients. These findings are partly related to the fact that the newer agents are used in younger and less ill patients.

KEYWORDS:

Acute coronary syndromes; Antiplatelet agents; Clopidogrel; Effectiveness; Methodology; Observational; P2Y12 receptor inhibitors; Prasugrel; Real-world evidence; ST-segment elevation myocardial infarction; Safety; Ticagrelor

PMID:
27533757
DOI:
10.1093/ehjcvp/pvw003
[Indexed for MEDLINE]

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