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.
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.
Authors: Clara Bonanad; Francisca Esteve-Claramunt; Sergio García-Blas; Ana Ayesta; Pablo Díez-Villanueva; Jose-Ángel Pérez-Rivera; José Luis Ferreiro; Joaquim Cánoves; Francisco López-Fornás; Albert Ariza Solé; Sergio Raposerias; David Vivas; Regina Blanco; Daznia Bompart Berroterán; Alberto Cordero; Julio Núñez; Lorenzo Fácila; Iván J Núñez-Gil; José Luis Górriz; Vicente Bodí; Manuel Martínez-Selles; Juan Miguel Ruiz Nodar; Francisco Javier Chorro Journal: J Clin Med Date: 2022-05-26 Impact factor: 4.964
Authors: Juan Miguel Ruiz-Nodar; María Asunción Esteve-Pastor; Jose Miguel Rivera-Caravaca; Miriam Sandín; Teresa Lozano; Nuria Vicente-Ibarra; Esteban Orenes-Piñero; Manuel Jesús Macías; Vicente Pernías; Luna Carrillo; Elena Candela; Andrea Veliz; Antonio Tello-Montoliu; Juan Gabriel Martínez Martínez; Francisco Marín Journal: Br J Clin Pharmacol Date: 2020-02-03 Impact factor: 4.335
Authors: Sukhdeep S Basra; Tracy Y Wang; DaJuanicia N Simon; Karen Chiswell; Salim S Virani; Mahboob Alam; Vijay Nambi; Ali E Denktas; Anita Deswal; Biykem Bozkurt; Christie M Ballantyne; Eric D Peterson; Hani Jneid Journal: J Am Heart Assoc Date: 2018-06-09 Impact factor: 5.501
Authors: Elena Candela; Francisco Marín; José Miguel Rivera-Caravaca; Nuria Vicente Ibarra; Luna Carrillo; María Asunción Esteve-Pastor; Teresa Lozano; Manuel Jesús Macías; Vicente Pernias; Miriam Sandín; Esteban Orenes-Piñero; Miriam Quintana-Giner; Ignacio Hortelano; Beatriz Villamía; Andrea Veliz; Mariano Valdés; Juan G Martínez-Martínez; Juan M Ruiz-Nodar Journal: PLoS One Date: 2018-11-28 Impact factor: 3.240