In:
Cardiology, S. Karger AG, Vol. 136, No. 1 ( 2017), p. 21-28
Kurzfassung:
〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To assess the real-world use, clinical outcomes, and adherence to novel P 〈 sub 〉 2 〈 /sub 〉 Y 〈 sub 〉 12 〈 /sub 〉 inhibitors. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 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 P 〈 sub 〉 2 〈 /sub 〉 Y 〈 sub 〉 12 〈 /sub 〉 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). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Novel P 〈 sub 〉 2 〈 /sub 〉 Y 〈 sub 〉 12 〈 /sub 〉 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 P 〈 sub 〉 2 〈 /sub 〉 Y 〈 sub 〉 12 〈 /sub 〉 inhibitors (11 vs. 5%, p = 0.03). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In a real-world cohort, there was an underutilization of novel P 〈 sub 〉 2 〈 /sub 〉 Y 〈 sub 〉 12 〈 /sub 〉 inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P 〈 sub 〉 2 〈 /sub 〉 Y 〈 sub 〉 12 〈 /sub 〉 inhibitors at least as much as other patients.
Materialart:
Online-Ressource
ISSN:
0008-6312
,
1421-9751
Sprache:
Englisch
Verlag:
S. Karger AG
Publikationsdatum:
2017
ZDB Id:
1482041-9
