Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't
PubMed
27533757
DOI
10.1093/ehjcvp/pvw003
PII: pvw003
Knihovny.cz E-resources
- Keywords
- Acute coronary syndromes, Antiplatelet agents, Clopidogrel, Effectiveness, Methodology, Observational, P2Y12 receptor inhibitors, Prasugrel, Real-world evidence, ST-segment elevation myocardial infarction, Safety, Ticagrelor,
- MeSH
- Adult MeSH
- ST Elevation Myocardial Infarction complications drug therapy mortality MeSH
- Ischemia mortality prevention & control MeSH
- Hemorrhage chemically induced epidemiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Purinergic P2Y Receptor Antagonists adverse effects therapeutic use MeSH
- Receptors, Purinergic P2Y12 drug effects MeSH
- Registries MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Endpoint Determination MeSH
- Patient Selection MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- Names of Substances
- Purinergic P2Y Receptor Antagonists MeSH
- Receptors, Purinergic P2Y12 MeSH
AIMS: Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in patients with STEMI based on the data from contemporary European ACS registries. METHODS AND RESULTS: Twelve registries provided data in a systematic manner on outcomes in STEMI patients overall, and seven of these also provided data for P2Y12 receptor inhibitor-based dual antiplatelet therapy. The registries were heterogeneous in terms of site, patient, and treatment selection, as well as in definition of endpoints (e.g. bleeding events). All-cause death rates based on the data from 84 299 patients (9612 patients on prasugrel, 11 492 on ticagrelor, and 27 824 on clopidogrel) ranged between 0.49 and 6.68% in-hospital, between 3.07 and 7.95% at 30 days (reported in 6 registries), between 8.15 and 9.13% at 180 days, and between 2.41 and 9.58% at 1 year (5 registries). Major bleeding rates were 0.09-3.55% in-hospital (8 registries), 0.09-1.65% at 30 days, and 1.96% at 1 year (only 1 registry). Fatal/life-threatening bleeding was rare occurring between 0.08 and 0.13% in-hospital (4 registries) and 1.96% at 1 year (1 registry). CONCLUSIONS: Real-world evidence from European contemporary registries shows that death, ischaemic events, and bleeding rates are lower than those reported in Phase III studies of P2Y12 inhibitors. Regarding individual P2Y12 inhibitors, patients on prasugrel, and, to a lesser degree, ticagrelor, had fewer ischaemic and bleeding events at all time points than clopidogrel-treated patients. These findings are partly related to the fact that the newer agents are used in younger and less ill patients.
2nd Department of Medicine with Cardiology and Intensive Care Hospital Rudolfstiftung Vienna Austria
AMIS Plus Data Center University of Zurich Zurich Switzerland
Cardiocenter 3rd Faculty of Medicine Charles University Prague Czech Republic
Cardiology Department Hospital La Paz IdiPaz Madrid Spain
Cardiology Freeman Hospital and Institute of Cellular Medicine Newcastle Upon Tyne UK
Cardiology Service Hospital Universitari de Tarragona Joan XXIII IISPV Tarragona Spain
Cardiology Service Hospital Universitari Vall d'Hebron Barcelona Spain
Cardiology Unit Humanitas Research Hospital Rozzano Italy
Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Department of Cardiology Lund University Skåne University Hospital Lund Sweden
Department of Cardiology Skåne University Hospital Lund Sweden
Department of Cardiology University Hospital Antwerp Edegem Belgium
Interventional Cardiology Institut für Herzinfarktforschung Ludwigshafen Germany
References provided by Crossref.org
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