What’s new?
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Real-world data with current potent antiplatelet therapies is limited to low frequency use.
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A single antiplatelet therapy protocol was successfully implemented in 8 non-PCI-capable and 3 PCI-capable collaborating hospitals for all ACS patients.
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This resulted in a high penetration of current potent antiplatelet therapies with a low prescription rate for non-recommended or contra-indicated patients
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Within the high frequency use real-world data population no excess major bleeding events were observed.
Introduction
Methods
Study design and population
Data collection and event validation
Study endpoints
Statistical analysis
Results
Demographic characteristics
All patients (N = 4,258) | Patients receiving clopidogrel at discharge (N = 1,420) | Patients receiving prasugrel at discharge (N = 2,677) | |
---|---|---|---|
Demographics
| |||
Age, year | 64 (54, 73) | 73 (62, 79) | 60 (52, 68) |
Age ≥ 75 | 21.5 | 45.1 | 7.8 |
Woman | 27.5 | 35.7 | 23.0 |
Weight, kg | 80 (73, 91) | 80 (70, 90) | 82 (74, 93) |
Weight <60 kg | 4.0 | 5.9 | 2.9 |
Cardiovascular risk factors
| |||
Diabetes mellitus | 17.0 | 21.5 | 14.0 |
Hypertension | 51.6 | 61.9 | 45.6 |
Hypercholesterolaemia | 37.6 | 41.9 | 35.1 |
Current smoking | 36.0 | 21.9 | 43.6 |
Family history of CAD | 44.3 | 39.5 | 47.6 |
Cardiovascular disease history
| |||
MI | 18.3 | 24.5 | 15.0 |
PCI | 18.0 | 25.1 | 14.4 |
CABG | 5.6 | 10.3 | 3.2 |
Stroke or TIA | 7.3 | 18.4 | 0.9 |
Peripheral artery disease | 7.2 | 10.7 | 4.8 |
Congestive heart failure | 3.8 | 5.6 | 2.7 |
Laboratory findings
| |||
Creatinine, µmol/l | 80 (69, 95) | 83 (70, 101) | 78 (68, 91) |
Haemoglobin, mmol/l | 8.9 (8.2, 9.5) | 8.7 (7.9, 9.3) | 9.0 (8.4, 9.6) |
Thrombocytes, •109/l | 234 (195, 277) | 233 (194, 277) | 234 (196, 278) |
Positive (>13 ng/l) high-sensitivity troponin test during admission | 85.4 | 79.8 | 87.9 |
Presentation
| |||
Admission diagnosis | |||
– Unstable angina | 19.4 | 28.4 | 15.2 |
– NSTEMI | 36.9 | 43.3 | 34.6 |
– STEMI | 43.8 | 28.3 | 50.1 |
Left ventricular function
a
| |||
– Normal (≥50%) | 66.1 | 63.2 | 68.2 |
– Moderate (30–49%) | 29.4 | 30.5 | 28.7 |
– Poor (<30%) | 4.5 | 6.3 | 3.1 |
Timings and durations | N = 2,677 |
---|---|
Admission to PCI, days (by diagnosis) | |
– Unstable angina | 2.0 (0, 4.0) |
– NSTEMI | 1.0 (0, 4.0) |
– STEMI | 0 (0, 0) |
Admission duration, days | 4.0 (3.0, 6.0) |
Procedural characteristics
| |
Access site | |
– Femoral | 39.1 |
– Radial | 56.2 |
– Other | 4.7 |
Treated vessel | |
– Right coronary artery | 37.1 |
– Left main | 2.5 |
– Left anterior descending | 46.8 |
– Left circumflex | 25.2 |
– Arterial or saphenous grafts | 1.3 |
Multivessel PCI during index procedure | 13.5 |
Periprocedural antithrombotic treatment
| |
Aspirin | 88.3 |
Clopidogrel | 12.6 |
Prasugrel | 78.5 |
Clopidogrel and prasugrel | 0.7 |
Glycoprotein IIb/IIIa inhibitor | 17.0 |
Unfractionated heparina | 100 |
Low-molecular-weight heparin | 2.7 |
Pharmacological treatment
Outcomes
In-hospital | 1 montha | 1 yearb | |
---|---|---|---|
Composite efficacy outcomes
| |||
All-cause death or MI (primary endpoint) | 13 (0.5) | 22 (0.8) | 64 (2.4) |
Cardiovascular death, MI or TVR | 23 (0.9) | 41 (1.5) | 119 (4.4) |
Single efficacy outcomes
| |||
All-cause death | – | 4 (0.2) | 28 (1.0) |
Cardiovascular death | – | 4 (0.2) | 17 (0.6) |
MI | 13 (0.5) | 19 (0.7) | 39 (1.5) |
Stent thrombosis | 5 (0.2) | 12 (0.4) | 16 (0.6) |
– Definite | 5 | 11 | 13 |
– Probable | 0 | 1 | 1 |
– Possible | 0 | 0 | 2 |
TLR | 10 (0.4) | 17 (0.6) | 44 (1.6) |
TVR | 16 (0.6) | 30 (1.1) | 83 (3.1) |
CABG | 2 (0.1) | 6 (0.2) | 22 (0.8) |
Stroke | 3 (0.1) | 8 (0.3) | 13 (0.5) |
Safety outcome
| |||
Non-CABG TIMI major bleeding | 14 (0.5) | 20 (0.8) | 37 (1.4) |
– Access site | 5 | 7 | 10 |
– Gastrointestinal | 2 | 3 | 8 |
– Intracranial | 0 | 2 | 6 |
– Other | 7 | 8 | 13 |