Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital Revascularization.
Abstract
BACKGROUND: While use of P2Y12 receptor inhibitor is recommended by guidelines, few
studies have examined its effectiveness among older non-ST-segment elevation myocardial
infarction patients who did not undergo coronary revascularization. METHODS AND RESULTS:
We included unrevascularized non-ST-segment elevation myocardial infarction patients
≥65 years discharged home from 463 ACTION Registry-GWTG hospitals from 2007 to 2010.
Rates of discharge clopidogrel use were described for patients with no angiography,
angiography without obstructive coronary artery disease (CAD; ≥50% stenosis in ≥1
vessel), and angiography with obstructive CAD. Two-year outcomes were ascertained
from linked Medicare data and included composite major adverse cardiac events (defined
as all-cause death, myocardial infarction readmission, or revascularization), and
individual components. Outcomes associated with clopidogrel use were adjusted using
inverse probability-weighted propensity modeling. Of 14 154 unrevascularized patients,
54.7% (n=7745) did not undergo angiography, 10.6% (n=1494) had angiography without
CAD, and 34.7% (n=4915) had angiography with CAD. Discharge clopidogrel was prescribed
for 42.2% of all unrevascularized patients: 37.8% without angiography, 34.1% without
obstructive CAD at angiography, and 51.6% with obstructive CAD at angiography. Discharge
clopidogrel use was not associated with major adverse cardiac events in any group:
without angiography (adjusted hazard ratio [95% CI]: 0.99 [0.93-1.06]), angiography
without CAD (1.04 [0.74-1.47]), and angiography with CAD (1.12 [1.00-1.25], Pinteraction=0.20).
CONCLUSIONS: We found no association between discharge clopidogrel use and long-term
risk of major adverse cardiac events among older, unrevascularized non-ST-segment
elevation myocardial infarction patients. Clopidogrel use in this population requires
further prospective evaluation.
Type
Journal articleSubject
P2Y12 receptor inhibitoreffectiveness
unrevascularized non–ST‐segment elevation myocardial infarction patients
Age Factors
Aged
Aged, 80 and over
Cardiac Catheterization
Coronary Angiography
Coronary Artery Disease
Female
Humans
Male
Medicare
Myocardial Infarction
Myocardial Revascularization
Patient Discharge
Platelet Aggregation Inhibitors
Purinergic P2Y Receptor Antagonists
Referral and Consultation
Registries
Risk Factors
Ticlopidine
Time Factors
Treatment Outcome
United States
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https://hdl.handle.net/10161/14992Published Version (Please cite this version)
10.1161/JAHA.115.002784Publication Info
Hess, Connie N; Hellkamp, Anne S; Roe, Matthew T; Thomas, Laine; Scirica, Benjamin
M; Peng, S Andrew; ... Wang, Tracy Y (2016). Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare
Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital
Revascularization. J Am Heart Assoc, 5(3). pp. e002784. 10.1161/JAHA.115.002784. Retrieved from https://hdl.handle.net/10161/14992.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,
Laine Elliott Thomas
Professor of Biostatistics & Bioinformatics
As Deputy Director, Laine Thomas, PhD provides complementary leadership in strategy
and development of the group and DCRI. She has an outstanding record of scientific
and strategic collaboration, independent research, leadership and mentoring well known
to her colleagues at the DCRI.
Thomas joined the DCRI in 2009. She serves as Associate Director for Biostatistics
at DCRI and Associate Chair for Equity, Diversity and Inclusion within the Department
of
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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