1
|
Toušek P, Bauer D, Neuberg M, Nováčková M, Mašek P, Tu Ma P, Kočka V, Moťovská Z, Widimský P. Patient characteristics, treatment strategy, outcomes, and hospital costs of acute coronary syndrome: 3 years of data from a large high-volume centre in Central Europe. Eur Heart J Suppl 2022; 24:B3-B9. [PMID: 35370502 PMCID: PMC8971736 DOI: 10.1093/eurheartjsupp/suac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Managing patients with acute coronary syndrome (ACS) in an ageing population with comorbidities is clinically and economically challenging. Well-conducted unselected registries are essential for providing information on real-day clinical practice. The aim was to create a long term, very detail-controlled registry of unselected patients admitted with ACS to a high-volume centre in Central Europe. Consecutive patients admitted with confirmed ACS were entered into the prospective registry from 1 October 2018 to 30 September 2021. Data on 214 parameters, including clinical characteristics, angiographic findings, laboratory and therapeutic findings, financial costs, and in-hospital mortality, were obtained for all patients. Analyses were performed on the complete dataset of 1804 patients. Of these patients, 694 (38.5%) were admitted for ST-segment elevation myocardial infarction (STEMI) and 1110 (61.5%) were admitted for non-ST-elevation (NSTE)-ACS [779 with NSTE myocardial infarction (NSTE-MI) and 331 with unstable angina (UA)]. Almost all patients (99%) underwent coronary angiography. Primary percutaneous coronary intervention (PCI) was performed in 93.4% of STEMI patients and 74.5% of NSTE-ACS patients. Patients with NSTE-MI had the longest total hospital stay (8.1 ± 9.1 days) and highest financial costs (8579.5 ± 7173.2 euros). In-hospital mortality was 1.2% in UA, 6.2% in NSTE-MI, and 10.9% in STEMI patients. Age older than 75 years, pre-hospital cardiac arrest and/or mechanical ventilation, subacute STEMI, and ejection fraction below 40% were the most powerful predictors of in-hospital mortality as assessed by multivariate analyses. The in-hospital mortality of unselected NSTE-MI and STEMI patients in daily practice is not low despite very good implementation of guideline-recommended therapy with a high rate of revascularization. The highest financial costs are associated with NSTE-MI.
Collapse
Affiliation(s)
- Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - David Bauer
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Marek Neuberg
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Markéta Nováčková
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Mašek
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Petr Tu Ma
- Medtronic Czechia, Partner of INTERCARDIS Project, Prosecká 852/66, Prague, 190 00, Czech Republic
| | - Viktor Kočka
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Zuzana Moťovská
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Widimský
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| |
Collapse
|
2
|
Abstract
Antiplatelet therapy is the mainstay of treatment and secondary prevention of cardiovascular disease (CVD), including acute coronary syndrome (ACS), transient ischemic attack (TIA) or minor stroke, and peripheral artery disease (PAD). The P2Y12 inhibitors, of which clopidogrel was the first, play an integral role in antiplatelet therapy and therefore in the treatment and secondary prevention of CVD. This review discusses the available evidence concerning antiplatelet therapy in patients with CVD, with a focus on the role of clopidogrel. In combination with aspirin, clopidogrel is often used as part of dual antiplatelet therapy (DAPT) for the secondary prevention of ACS. Although newer, more potent P2Y12 inhibitors (prasugrel and ticagrelor) show a greater reduction in ischemic risk compared with clopidogrel in randomized trials of ACS patients, these newer P2Y12 inhibitors are often associated with an increased risk of bleeding. Deescalation of DAPT by switching from prasugrel or ticagrelor to clopidogrel may be required in some patients with ACS. Furthermore, real-world studies of ACS patients have not confirmed the benefits of the newer P2Y12 inhibitors over clopidogrel. In patients with very high-risk TIA or stroke, short-term DAPT with clopidogrel plus aspirin for 21-28 days, followed by clopidogrel monotherapy for up to 90 days, is recommended. Clopidogrel monotherapy may also be used in patients with symptomatic PAD. In conclusion, there is strong evidence supporting the use of clopidogrel antiplatelet therapy in several clinical settings, which emphasizes the importance of this medication in clinical practice.
Collapse
|
3
|
Agewall S. Antiplatelet treatment in coronary syndrome. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:81-82. [PMID: 33720341 DOI: 10.1093/ehjcvp/pvab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Stefan Agewall
- Editor-in-Chief, Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
De Luca L, Zeymer U, Claeys MJ, Dörler J, Erne P, Matter CM, Radovanovic D, Weidinger F, Lüscher TF, Jukema JW. Comparison of P2Y12 receptor inhibitors in patients with ST-elevation myocardial infarction in clinical practice: a propensity score analysis of five contemporary European registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:94-103. [PMID: 31965164 PMCID: PMC7957904 DOI: 10.1093/ehjcvp/pvaa002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 01/12/2023]
Abstract
Aims Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries. Methods and results Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62–0.84, P < 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77–1.23; P = 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor. Conclusion This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety.
Collapse
Affiliation(s)
- Leonardo De Luca
- Interventional Cardiology Unit, Division of Cardiology, San Giovanni Evangelista Hospital, Via A. Parrozzani 3, I-00019 Tivoli, Rome, Italy
| | - Uwe Zeymer
- Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Jakob Dörler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Erne
- Faculty of Biomedical Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Christian M Matter
- Cardiology Department, University Heart Center, AQ8University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Franz Weidinger
- 2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria
| | - Thomas F Lüscher
- Heart Division, Royal Brompton & Harefield Hospital, Imperial College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Johan Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
5
|
Agewall S. Adherence to guidelines and registry data. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 3:183-184. [PMID: 28922837 DOI: 10.1093/ehjcvp/pvx027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
6
|
Goss F, Brachmann J, Hamm CW, Haerer W, Reifart N, Levenson B. High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study. Vasc Health Risk Manag 2017; 13:127-137. [PMID: 28435280 PMCID: PMC5388240 DOI: 10.2147/vhrm.s119490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy. Participating centers (36 hospitals, 60 office-based cardiologists) included a total of 1,003 patients with ACS (ST-segment elevation myocardial infarction [STEMI] 44.3%, non-ST-segment elevation myocardial infarction [NSTEMI] 39.5%, unstable angina pectoris [UA] 15.2%, and unspecified 1.0%). During follow-up, treatment rates with cardiac medication remained high in all groups, with dual antiplatelet therapy in 91.0% at 3 months, 90.0% at 6 months, and 82.8% at 12 months, respectively. Twelve months after the inclusion, a total of 798 patients (79.6%) still participated in the program. Eighteen patients (1.8%) had died after discharge from hospital (6 in the STEMI, 12 in the NSTEMI group), while for 58 the status was unknown (5.8%). Based on a conservative approach that considered patients with unknown status as dead, 1-year mortality was 7.6%. Recurrent cardiac events were noted in 14.9% at 1 year, with an about equal distribution across STEMI and NSTEMI patients. In conclusion, patients’ acceptance of the ProAcor program as determined by adherence rates over time was high. Treatment rates of recommended medications used for patients with coronary heart disease were excellent. The 1-year mortality rate was comparatively low.
Collapse
Affiliation(s)
| | | | | | | | - Nicolaus Reifart
- Kardiologische Praxis Prof. Reifart & Partner, Bad Soden, Germany
| | - Benny Levenson
- Kardiologische Gemeinschaftspraxis und Herzkatheterlabor Berlin-Charlottenburg, Berlin, Germany
| |
Collapse
|
7
|
Cardiovascular pharmacotherapy. Int J Cardiol 2016; 224:412-415. [PMID: 27690338 DOI: 10.1016/j.ijcard.2016.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022]
|
8
|
Agewall S. The application to MEDLINE from European Heart Journal-Cardiovascular Pharmacotherapy has been accepted! EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:207-208. [PMID: 27600901 DOI: 10.1093/ehjcvp/pvw021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Stefan Agewall
- Editor-in-Chief, Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Lewis BS. Cardiovascular pharmacotherapy-2015 was a good year. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:209-11. [PMID: 27600902 DOI: 10.1093/ehjcvp/pvw020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Basil S Lewis
- Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
10
|
Zeymer U, Widimsky P, Danchin N, Lettino M, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Sendón JL, Tousek P, Weidinger F, Weston CFM, Zaman A, Andell P, Li J, Jukema JW. P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:229-43. [DOI: 10.1093/ehjcvp/pvw005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/01/2016] [Indexed: 12/22/2022]
|
11
|
Danchin N, Lettino M, Zeymer U, Widimsky P, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez Sendón J, Tousek P, Weidinger F, Weston CFM, Zaman A, Andell P, Li J, Jukema JW. Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:152-67. [PMID: 27533757 DOI: 10.1093/ehjcvp/pvw003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/20/2016] [Indexed: 11/13/2022]
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 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.
Collapse
Affiliation(s)
- Nicolas Danchin
- Department of Cardiology, Hospital Europeen Georges Pompidou, AP-HP, Paris, France Université Paris Descartes, Paris, France
| | - Maddalena Lettino
- Cardiology Unit Humanitas Research Hospital, Rozzano (Milano), Italy
| | - Uwe Zeymer
- Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alfredo Bardaji
- Cardiology Service, Hospital Universitari de Tarragona Joan XXIII, IISPV Tarragona, Spain
| | - Jose A Barrabes
- Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Angel Cequier
- Heart Disease Institute Bellvitge University Hospital IDIBELL, University of Barcelona, Barcelona, Spain
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Leonardo De Luca
- Department of Cardiovascular Sciences, Laboratory of Interventional Cardiology European Hospital, Rome, Italy
| | - Jakob Dörler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Erlinge
- Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Paul Erne
- AMIS-Plus Data Center University of Zurich, Zurich, Switzerland
| | - Patrick Goldstein
- Pôle de l'urgence, Service de SAMU du Nord, Centre Hospitalier régional Universitaire de Lille, Lille, France
| | - Sasha M Koul
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Gilles Lemesle
- Cardiac Intensive Care Unit, Interventional Cardiology Hopital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gilles Montalescot
- Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Franz Weidinger
- 2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria
| | | | - Azfar Zaman
- Cardiology Freeman Hospital and Institute of Cellular Medicine, Newcastle Upon Tyne, UK
| | - Pontus Andell
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Jin Li
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
12
|
Guo LZ, Kim MH, Shim CH, Choi SY, Serebruany VL. Impact of renal impairment on platelet reactivity and clinical outcomes during chronic dual antiplatelet therapy following coronary stenting. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:145-51. [DOI: 10.1093/ehjcvp/pvv052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/07/2015] [Indexed: 01/09/2023]
|
13
|
|