Baseline characteristics, adenosine diphosphate receptor inhibitor treatment patterns, and in-hospital outcomes of myocardial infarction patients undergoing percutaneous coronary intervention in the prospective Canadian Observational AntiPlatelet sTudy (COAPT) - 04/11/16

Doi : 10.1016/j.ahj.2016.07.014

Jean-Pierre Déry, MD, MSc ^a, Shamir R. Mehta, MD, MSc ^b, Harold N. Fisher, MD ^c, Xiang Zhang, PhD ^d, Yajun Emily Zhu, MSc ^d, Robert C. Welsh, MD ^e, Shahar Lavi, MD ^f, Tomas Cieza, MD ^g,^h, Mark A. Henderson, MD ⁱ, Sohrab Lutchmedial, MD, CM ^j, Anthony J. Della Siega, MD ^k, Asim N. Cheema, MD ^l, Brian Y.L. Wong, MD ^m, Andre Kokis, MD ⁿ, Payam Dehghani, MD ^o, Shaun G. Goodman, MD, MSc ^l,^p,^{^⁎}
for the
Canadian Observational AntiPlatelet sTudy (COAPT) Investigators
^a Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
^b Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
^c Eli Lilly Canada Inc., Toronto, Ontario, Canada
^d Eli Lilly and Company, Indianapolis, IN
^e Mazankowski Alberta Heart Institute, University of Alberta Hospital, Canadian VIGOUR Centre, Edmonton, Alberta, Canada
^f London Health Sciences Centre, Western University, London, Ontario, Canada
^g CSSS Chicoutimi, Université de Sherbrooke, Sherbrooke, Quebec, Canada
^h Centre hospitalier universitaire de Québec (CHUQ), Université Laval, Quebec City, Quebec, Canada
ⁱ Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
^j New Brunswick Heart Centre, CardioVascular Research NB, Saint John, New Brunswick, Canada
^k Royal Jubilee Hospital and Victoria Heart Institute, Victoria, British Columbia, Canada
^l St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
^m Health Sciences North, Sudbury, Ontario, Canada
ⁿ CHUM—Hotel-Dieu, University of Montreal, Montreal, Quebec, Canada
^o Prairie Vascular Research Network, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
^p Canadian Heart Research Centre, Toronto, Ontario, Canada

^⁎Reprint requests: Shaun G. Goodman, MD, MSc, St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8.St Michael's Hospital30 Bond StTorontoONM5B 1W8Canada

Abstract

Background

Contemporary use of dual antiplatelet therapy and consistency with guideline recommendations in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) have not been well characterized.

Methods

The COAPT was a prospective, observational, multicenter, longitudinal study of patients with myocardial infarction (MI) undergoing PCI. Baseline characteristics, treatment patterns, processes of care, factors associated with switching to and from novel adenosine diphosphate receptor inhibitors (ADPris), and in-hospital outcomes are described.

Results

Among 2,179 MI patients undergoing PCI during their index hospitalization, 1,328 (60.9%) had ST elevation. Initial ADPri use included clopidogrel in 1,812 (83.2%), prasugrel in 125 (5.7%), and ticagrelor in 242 (11.1%). At discharge, 1,597 patients (73.4%) were prescribed clopidogrel, 220 (10.1%) prasugrel, and 358 (16.5%) ticagrelor. Switching between ADPri therapies during the index hospitalization occurred in 15.3%, 22.4%, and 25.2% of patients initially started on clopidogrel, prasugrel, and ticagrelor, respectively. Most switches over the 15-month study period occurred during the index admission (16.8% of patients vs 4.4% switches postdischarge). Major adverse cardiovascular events occurred in 7.5% of patients during the index hospitalization. In-hospital bleeding events occurred in 6.0% of patients and most were mild.

Conclusions

Despite randomized trial evidence and guideline recommendations, only a minority of Canadian MI patients undergoing PCI initially received or were discharged on one of the newer ADPri agents. These findings suggest an opportunity to improve upon the appropriate selection of the ADPris at index hospitalization and discharge in Canadian MI patients undergoing PCI.

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Plan

Data collection and treatment outcomes

Study design, funding, and management

Results

Baseline demographic and presentation characteristics

Oral antiplatelet therapy and processes of care

Other therapies

In-hospital cardiovascular and bleeding events

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Vol 181

P. 26-34 - novembre 2016 Retour au numéro

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Baseline characteristics, adenosine diphosphate receptor inhibitor treatment patterns, and in-hospital outcomes of myocardial infarction patients undergoing percutaneous coronary intervention in the prospective Canadian Observational AntiPlatelet sTudy (COAPT) - 04/11/16

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