P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries

• Published in: European heart journal. Cardiovascular pharmacotherapy Vol. 2; no. 4; pp. 229 - 243
• Main Authors: Zeymer, Uwe, Widimsky, Petr, Danchin, Nicolas, Lettino, Maddalena, Bardaji, Alfredo, Barrabes, Jose A., Cequier, Angel, Claeys, Marc J., De Luca, Leonardo, Dörler, Jakob, Erlinge, David, Erne, Paul, Goldstein, Patrick, Koul, Sasha M., Lemesle, Gilles, Lüscher, Thomas F., Matter, Christian M., Montalescot, Gilles, Radovanovic, Dragana, Sendón, Jose Lopez, Tousek, Petr, Weidinger, Franz, Weston, Clive F. M., Zaman, Azfar, Andell, Pontus, Li, Jin, Jukema, J. Wouter
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.10.2016
• Subjects: Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Adult; Aged; Aged, 80 and over; Clinical medicine; Drug Therapy, Combination; Europe; Female; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Ischemia - etiology; Ischemia - prevention & control; Male; Middle Aged; Patient Selection; Patients; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Purinergic P2Y Receptor Antagonists - adverse effects; Purinergic P2Y Receptor Antagonists - therapeutic use; Receptors, Purinergic P2Y12; Registries; Treatment Outcome; Prasugrel; Observational; Antiplatelets; Clopidogrel; Non-ST-segment elevation; Acute coronary syndromes; Ticagrelor; P2Y12 receptor inhibitors
• ISSN: 2055-6837; 2055-6845
• DOI: 10.1093/ehjcvp/pvw005

Abstract Aims Non-ST-elevation acute coronary syndrome (NSTE-ACS) is present in about 60–70% of patients admitted with acute coronary syndromes in clinical practice. This study provides a ‘real-life’ overview of NSTE-ACS patient characteristics, dual antiplatelet therapy clinical practice, and outcomes at both the time of discharge from hospital and up to 1-year post-discharge. Methods and results A total of 10 registries (documenting 84 054 NSTE-ACS patients) provided data in a systematic manner on patient characteristics and outcomes for NSTE-ACS in general, and 6 of these (with 52 173 NSTE-ACS patients) also provided more specific data according to P2Y12 receptor inhibitor used. Unadjusted analyses were performed at the study level, and no formal meta-analysis was performed due to large heterogeneity between studies in the settings, patient characteristics, and outcome definitions. All-cause death rates across registries ranged from 0.76 to 4.79% in-hospital, from 1.61 to 6.65% at 30 days, from 3.66 to 7.16% at 180 days, and from 3.14 to 9.73% at 1 year. Major bleeding events were reported in up to 2.77% of patients while in hospital (in seven registries), up to 1.08% at 30 days (data from one registry only), and 2.06% at 1 year (one registry). Conclusions There were substantial differences in the use of and patient selection for clopidogrel, prasugrel, and ticagrelor, which were associated with differences in short- and long-term ischaemic and bleeding events. In future registries, data collection should be performed in a more standardized way with respect to endpoints, definitions, and time points.