Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.
Abstract
BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction
(MI) patients. Novel agents in this class are now available in the US. We studied
the introduction of prasugrel into contemporary MI practice to understand the appropriateness
of its use and assess for changes in antiplatelet management practices. METHODS AND
RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns
of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial
infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients
at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist
use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to
2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2%
to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed
a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients.
Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel
was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In
both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest
predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel
was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS:
With prasugrel as an antiplatelet treatment option, contemporary practice shows low
uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients.
We also note concerning evidence of inappropriate use of prasugrel, and inadequate
targeting of this more potent therapy to maximize the benefit/risk ratio.
Type
Journal articleSubject
P2Y12 antagonistmyocardial infarction
prasugrel
Aged
Drug Administration Schedule
Drug Utilization Review
Female
Guideline Adherence
Hemorrhage
Humans
Male
Middle Aged
Myocardial Infarction
Piperazines
Platelet Aggregation Inhibitors
Practice Guidelines as Topic
Practice Patterns, Physicians'
Prasugrel Hydrochloride
Purinergic P2Y Receptor Antagonists
Registries
Retrospective Studies
Thiophenes
Ticlopidine
Time Factors
Treatment Outcome
United States
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https://hdl.handle.net/10161/10320Published Version (Please cite this version)
10.1161/JAHA.114.000849Publication Info
Sherwood, Matthew W; Wiviott, Stephen D; Peng, S Andrew; Roe, Matthew T; Delemos,
James; Peterson, Eric D; & Wang, Tracy Y (2014). Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients
in the US: insights from the National Cardiovascular Data Registry. J Am Heart Assoc, 3(2). pp. e000849. 10.1161/JAHA.114.000849. Retrieved from https://hdl.handle.net/10161/10320.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Matthew Todd Roe
Adjunct Professor in the Department of Medicine
My clinical activities focus upon general, preventive, and acute care cardiology.
I round regularly on the inpatient general cardiology and coronary care unit (CCU)
services and i have a particular interest in the treatment and management of patients
with acute myocardial infarction and cardiogenic shock. In my outpatient clinic,
I care for patients with a variety of cardiovascular conditions include chronic coronary
artery disease, hypertension, hyperlipidemia, atrial fibrillation,
Matthew William Sherwood
Adjunct Assistant Professor in the Department of Medicine
I am striving to become a clinical and research leader in structural heart disease
and complex coronary disease, specifically in the use of antithrombotic agents after
structural heart interventions. I will also explore the significance of bleeding/vascular
complications and stroke in these patients as well as potential therapies such as
transfusion, and embolic protection devices.
Tracy Yu-Ping Wang
Professor of Medicine
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
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