Baseline Characteristics, Adenosine Diphosphate Receptor Inhibitor Treatment Patterns, and In-Hospital Outcomes of Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention in the Prospective Canadian Observational AntiPlatelet sTudy (COAPT)

• Published in: The American heart journal 2016-11, Vol.181, p.26-34
• Main Authors: Déry, Jean-Pierre, MD, Mehta, Shamir R., MD, MSc, Fisher, Harold N., MD, Zhang, Xiang, PhD, Zhu, Yajun Emily, MSc, Welsh, Robert C., MD, Lavi, Shahar, MD, Cieza, Tomas, MD, Henderson, Mark A., MD, Lutchmedial, Sohrab, MD, CM, Siega, Anthony J. Della, MD, Cheema, Asim N., MD, Wong, Brian Y.L., MD, Kokis, Andre, MD, Dehghani, Payam, MD, Goodman, Shaun G., MD, MSc
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Adenosine; Adenosine - analogs & derivatives; Adenosine - therapeutic use; Adult; Aged; Aged, 80 and over; Anticoagulants; Canada; Cardiovascular; Consent; Data collection; Drug Substitution; Emergency Medical Services; Emergency Service, Hospital; Enrollments; Family physicians; Female; Heart attacks; Hemorrhage - chemically induced; Hospitalization; Humans; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction - therapy; Non-ST Elevated Myocardial Infarction - therapy; Patients; Percutaneous Coronary Intervention; Prasugrel Hydrochloride - therapeutic use; Prospective Studies; Purinergic P2Y Receptor Antagonists - therapeutic use; ST Elevation Myocardial Infarction - therapy; Studies; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2016.07.014

Abstract Background Contemporary use of dual antiplatelet therapy and consistency with guideline recommendations in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has not been well characterized. Methods The Canadian Observational AntiPlatelet sTudy (COAPT) was a prospective, observational, multicenter, longitudinal study of patients with myocardial infarction (MI) undergoing PCI. Baseline characteristics, treatment patterns, processes of care, factors associated with switching to and from novel adenosine diphosphate receptor inhibitors (ADPris), and in-hospital outcomes are described. Results Among 2179 MI patients undergoing PCI during their index hospitalisation, 1328 (60.9%) had ST elevation. Initial ADPri use included clopidogrel in 1812 (83.2%), prasugrel in 125 (5.7%), and ticagrelor in 242 (11.1%). At discharge, 1597 patients (73.4%) were prescribed clopidogrel, 220 (10.1%) prasugrel and 358 (16.5%) ticagrelor. Switching between ADPri therapies during the index hospitalisation occurred in 15.3%, 22.4%, and 25.2% of patients initially started on clopidogrel, prasugrel, and ticagrelor, respectively. The majority of switches over the 15 month study period occurred during the index admission (16.8% of patients vs. 4.4% switches post-discharge). Major adverse cardiovascular events (MACE) occurred in 7.5% of patients during the index hospitalisation. In-hospital bleeding events occurred in 6.0% of patients and the majority were mild. Conclusions Despite randomized trial evidence and guideline recommendations, only a minority of Canadian MI patients undergoing PCI initially received or were discharged on one of the newer ADPri agents. These findings suggest an opportunity to improve upon the appropriate selection of the ADPris at index hospitalisation and discharge in Canadian MI patients undergoing PCI.