PMID- 27543467
OWN - NLM
STAT- MEDLINE
DCOM- 20170522
LR  - 20181113
IS  - 2213-3763 (Electronic)
IS  - 0019-4832 (Print)
IS  - 0019-4832 (Linking)
VI  - 68
IP  - 4
DP  - 2016 Jul-Aug
TI  - Trends in use of anti-thrombotic agents and outcomes in patients with 
      non-ST-segment elevation myocardial infarction (NSTEMI) managed with an invasive 
      strategy.
PG  - 464-72
LID - S0019-4832(15)00444-7 [pii]
LID - 10.1016/j.ihj.2015.09.036 [doi]
AB  - OBJECTIVE: To analyze trends in utilization of anti-thrombotic agents (ATA) and 
      in-hospital clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) 
      patients managed with an invasive strategy from 2007 to 2010. METHODS & RESULTS: 
      Using ACTION Registry((R))-GWTG data, we analyzed trends in use of ATA and 
      in-hospital clinical outcomes among 64,199 NSTEMI patients managed invasively 
      between 2007 and 2010. ATA included unfractionated heparin (UFH), low molecular 
      weight heparin (LMWH), glycoprotein IIb/IIIa inhibitors (GPI) and bivalirudin. 
      Although the proportion of NSTEMI patients treated with PCI within 48h of 
      hospital arrival was similar in 2007 and 2010, percentage use of bivalirudin 
      (13.4-27.3%; p<0.01) and UFH increased (60.0-67.5%, p<0.01), and that of GPI 
      (62.3-41.0%; p<0.01) and LMWH (41.5-36.8%; p<0.01) declined. Excess dosing of UFH 
      (75.9-59.3%, p<0.01), LMWH (9.6-5.2%; p<0.01) and GPI (8.9-5.9%, p<0.01) was also 
      significantly lower in 2010 compared with 2007. Though in-hospital mortality 
      rates were similar in 2007 and 2010 (2.3-1.9%, p=0.08), the rates of in-hospital 
      major bleeding (8.7-6.6%, p<0.01) and non-CABG related RBC transfusion (6.3-4.6%, 
      p<0.01) were significantly lower in 2010 compared with 2007. CONCLUSION: Compared 
      with 2007, patients with NSTEMI, who were managed invasively in 2010 received GPI 
      and LMWH less often and bivalirudin and UFH more frequently. There were sizeable 
      reductions in the rates of excess dosing of UFH (though still occurred in 67% of 
      patients), GPI and LMWH. In-hospital major bleeding complications and 
      post-procedural RBC transfusion were lower in 2010 compared with 2007.
CI  - Copyright (c) 2015 Cardiological Society of India. Published by Elsevier B.V. All 
      rights reserved.
FAU - Wayangankar, S A
AU  - Wayangankar SA
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States. Electronic 
      address: wayangs@ccf.org.
FAU - Roe, M T
AU  - Roe MT
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Chen, A Y
AU  - Chen AY
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Gupta, R S
AU  - Gupta RS
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Giugliano, R P
AU  - Giugliano RP
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Newby, L K
AU  - Newby LK
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - de Lemos, J A
AU  - de Lemos JA
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Alexander, K P
AU  - Alexander KP
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Sanborn, T A
AU  - Sanborn TA
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
FAU - Saucedo, J F
AU  - Saucedo JF
AD  - Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, 
      Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; 
      University of Texas Southwestern Medical Center, Dallas, TX, United States; 
      Northshore University Health System, Evanston, IL, United States.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20160118
PL  - India
TA  - Indian Heart J
JT  - Indian heart journal
JID - 0374675
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Antithrombins/administration & dosage
MH  - Dose-Response Relationship, Drug
MH  - Electrocardiography
MH  - Female
MH  - Fibrinolytic Agents/*administration & dosage
MH  - Follow-Up Studies
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Hirudins/*administration & dosage
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Non-ST Elevated Myocardial Infarction/diagnosis/*drug therapy/mortality
MH  - Peptide Fragments/*administration & dosage
MH  - Recombinant Proteins/administration & dosage
MH  - *Registries
MH  - Retrospective Studies
MH  - Time Factors
MH  - United States/epidemiology
PMC - PMC4990733
OTO - NOTNLM
OT  - Anti-thrombotic agents
OT  - Invasive strategy
OT  - Non-ST-segment elevation myocardial infarction
EDAT- 2016/08/21 06:00
MHDA- 2017/05/23 06:00
PMCR- 2017/07/01
CRDT- 2016/08/21 06:00
PHST- 2015/08/03 00:00 [received]
PHST- 2015/09/09 00:00 [revised]
PHST- 2015/09/29 00:00 [accepted]
PHST- 2016/08/21 06:00 [entrez]
PHST- 2016/08/21 06:00 [pubmed]
PHST- 2017/05/23 06:00 [medline]
PHST- 2017/07/01 00:00 [pmc-release]
AID - S0019-4832(15)00444-7 [pii]
AID - 10.1016/j.ihj.2015.09.036 [doi]
PST - ppublish
SO  - Indian Heart J. 2016 Jul-Aug;68(4):464-72. doi: 10.1016/j.ihj.2015.09.036. Epub 
      2016 Jan 18.