Under-prescription of novel antiplatelet drugs in patients with acute coronary syndrome and previous cardiovascular disease
Por:
Orenes-Pinero, E, Esteve-Pastor, M, Ruiz-Nodar, J, Quintana-Giner, M, Veliz-Martinez, A, Tello-Montoliu, A, Macias-Villanego, M, Pernias-Escrig, V, Vicente-Ibarra, N, Carrillo-Aleman, L, Sandin-Rollan, M, Martinez, J, Lozano, T, Rivera-Caravaca, J and Marin, F
Publicada:
1 oct 2019
Resumen:
BACKGROUND: Patients with acute coronary syndrome (ACS) and previous cardiovascular disease (CVD) (stroke, peripheral arterial disease [PAD] or coronary artery disease [CAD]) are at high risk of serious events and mortality. Current clinical guidelines recommend new antiplatelet drugs (NADs) for high cardiovascular risk patients with ACS; however, these drugs are underused in different scenarios.
METHODS: This study included 1717 ACS patients from 3 tertiary hospitals. Of them, 641 (37.33%) suffered from previous CVD: 149 patients with stroke, 154 patients with PAD and 541 patients with CAD. Bleeding, mortality and major adverse cardiac events (MACE) at 1 year of follow-up after hospital discharge were analyzed.
RESULTS: NADs administration during hospital stay and at discharge was less frequent in patients with previous CVDs (P<0.001, for both). Cox analysis in this cohort of patients showed that clopidogrel prescription at discharge was independently associated with MACEs (HR: 1.59 [95% CI: 1.03-2.45]; P=0.036) and with death (HR: 1.99 [95% CI: 1.00-3.98]; P=0.049) in multivariate analysis. More specifically, when ticagrelor prescription at discharge was compared with clopidogrel, a significant death reduction was found in both, the univariate and the multivariate Cox analysis (HR: 4.54 [95% CI: 2.26-9.13]; P<0.001 and HR: 2.61 [95% CI: 1.16-5.90]; P=0.021, respectively).
CONCLUSIONS: New antiplatelet drugs, especially ticagrelor, showed lower rates of mortality in patients with CVD without differences for bleeding. Despite the recommendations of current clinical guidelines for high risk patients with ACS, the use of NADs is very low in "real-life" patients with previous CVD.
Filiaciones:
Orenes-Pinero, E:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
Esteve-Pastor, M:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
:
Gen Univ Hosp Alicante, Dept Cardiol, Alicante, Spain
Quintana-Giner, M:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
Veliz-Martinez, A:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
Tello-Montoliu, A:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
:
Gen Univ Hosp Alicante, Dept Cardiol, Alicante, Spain
Pernias-Escrig, V:
Gen Univ Hosp Elche, Dept Cardiol, Alicante, Spain
Vicente-Ibarra, N:
Gen Univ Hosp Elche, Dept Cardiol, Alicante, Spain
:
Gen Univ Hosp Alicante, Dept Cardiol, Alicante, Spain
:
Gen Univ Hosp Alicante, Dept Cardiol, Alicante, Spain
:
Gen Univ Hosp Alicante, Dept Cardiol, Alicante, Spain
Lozano, T:
Gen Univ Hosp Alicante, Dept Cardiol, Alicante, Spain
Rivera-Caravaca, J:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
Marin, F:
Univ Murcia, CIBERCV, Dept Cardiol, Virgen Arrixaca Univ Hosp,IMIB Arrixaca, Murcia, Spain
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