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Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries

, ; Danchin, Nicolas; Lettino, Maddalena; Zeymer, Uwe; Widimsky, Petr; Bardaji, Alfredo; Barrabes, Jose A.; Cequier, Angel; Claeys, Marc J. and De Luca, Leonardo, et al. (2016) In European Heart Journal - Cardiovascular Pharmacotherapy 2(3). p.152-167
Abstract

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 registrieswere 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... (More)

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 registrieswere 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% inhospital (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.

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@article{19265e9e-af48-464f-85ac-843b0c09abb7,
  abstract     = {<p>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 registrieswere 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% inhospital (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.</p>},
  author       = {,  and Danchin, Nicolas and Lettino, Maddalena and Zeymer, Uwe and Widimsky, Petr and Bardaji, Alfredo and Barrabes, Jose A. and Cequier, Angel and Claeys, Marc J. and De Luca, Leonardo and Dörler, Jakob and Erlinge, David and Erne, Paul and Goldstein, Patrick and Koul, Sasha M. and Lemesle, Gilles and Lüscher, Thomas F. and Matter, Christian M. and Montalescot, Gilles and Radovanovic, Dragana and Sendón, Jose Lopez and Tousek, Petr and Weidinger, Franz and Weston, Clive F.M. and Zaman, Azfar and Andell, Pontus and Li, Jin and Jukema, J. Wouter},
  issn         = {2055-6837},
  keyword      = {Acute coronary syndromes,Antiplatelet agents,Clopidogrel,Effectiveness,Methodology,Observational,P2Y12 receptor inhibitors,Prasugrel,Real-world evidence,Safety,St-segment elevationmyocardial infarction,Ticagrelor},
  language     = {eng},
  month        = {07},
  number       = {3},
  pages        = {152--167},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal - Cardiovascular Pharmacotherapy},
  title        = {Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries},
  url          = {http://dx.doi.org/10.1093/ehjcvp/pvw003},
  volume       = {2},
  year         = {2016},
}