PMID- 24732921
OWN - NLM
STAT- MEDLINE
DCOM- 20141118
LR  - 20220330
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 3
IP  - 2
DP  - 2014 Apr 14
TI  - Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI 
      patients in the US: insights from the National Cardiovascular Data Registry.
PG  - e000849
LID - 10.1161/JAHA.114.000849 [doi]
LID - e000849
AB  - BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial 
      infarction (MI) patients. Novel agents in this class are now available in the US. 
      We studied the introduction of prasugrel into contemporary MI practice to 
      understand the appropriateness of its use and assess for changes in antiplatelet 
      management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG 
      (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 
      24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 
      158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals 
      between October 2009 and September 2012. Rates of early P2Y12 antagonist use were 
      approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, 
      prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 
      10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a 
      decrease in use of early but not discharge P2Y12 antagonist among NSTEMI 
      patients. Although contraindicated, 3.0% of patients with prior stroke received 
      prasugrel. Prasugrel was used in 1.9% of patients >/=75 years and 4.5% of patients 
      with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used 
      in patients at the lowest predicted risk for bleeding and mortality. Despite lack 
      of supporting evidence, prasugrel was initiated before cardiac catheterization in 
      18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment 
      option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 
      antagonist initiation among NSTEMI patients. We also note concerning evidence of 
      inappropriate use of prasugrel, and inadequate targeting of this more potent 
      therapy to maximize the benefit/risk ratio.
FAU - Sherwood, Matthew W
AU  - Sherwood MW
AD  - Division of Cardiovascular Medicine, Duke University Medical Center, Duke 
      Clinical Research Institute, Durham, NC.
FAU - Wiviott, Stephen D
AU  - Wiviott SD
FAU - Peng, S Andrew
AU  - Peng SA
FAU - Roe, Matthew T
AU  - Roe MT
FAU - Delemos, James
AU  - Delemos J
FAU - Peterson, Eric D
AU  - Peterson ED
FAU - Wang, Tracy Y
AU  - Wang TY
LA  - eng
GR  - U19 HS021092/HS/AHRQ HHS/United States
GR  - U19HS021092/HS/AHRQ HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20140414
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
RN  - 0 (Piperazines)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Purinergic P2Y Receptor Antagonists)
RN  - 0 (Thiophenes)
RN  - A74586SNO7 (Clopidogrel)
RN  - G89JQ59I13 (Prasugrel Hydrochloride)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Aged
MH  - Clopidogrel
MH  - Drug Administration Schedule
MH  - Drug Utilization Review
MH  - Female
MH  - Guideline Adherence/trends
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/diagnosis/*drug therapy/mortality
MH  - Piperazines/*administration & dosage/adverse effects
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/*trends
MH  - Prasugrel Hydrochloride
MH  - Purinergic P2Y Receptor Antagonists/*administration & dosage/adverse effects
MH  - Registries
MH  - Retrospective Studies
MH  - Thiophenes/*administration & dosage/adverse effects
MH  - Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
PMC - PMC4187510
OTO - NOTNLM
OT  - P2Y12 antagonist
OT  - myocardial infarction
OT  - prasugrel
EDAT- 2014/04/16 06:00
MHDA- 2014/11/19 06:00
PMCR- 2014/04/01
CRDT- 2014/04/16 06:00
PHST- 2014/04/16 06:00 [entrez]
PHST- 2014/04/16 06:00 [pubmed]
PHST- 2014/11/19 06:00 [medline]
PHST- 2014/04/01 00:00 [pmc-release]
AID - jah3499 [pii]
AID - 10.1161/JAHA.114.000849 [doi]
PST - epublish
SO  - J Am Heart Assoc. 2014 Apr 14;3(2):e000849. doi: 10.1161/JAHA.114.000849.