Switching between thienopyridines in patients with acute myocardial infarction and quality of care

Francois Schiele, Etienne Puymirat, Laurent Bonello, Nicolas Meneveau, Jean-Philippe Collet, Pascal Motreff, Ramin Ravan, Florence Leclercq, Pierre-Vladimir Ennezat, Jean Ferrières, Tabassome Simon, Nicolas Danchin, Francois Schiele, Etienne Puymirat, Laurent Bonello, Nicolas Meneveau, Jean-Philippe Collet, Pascal Motreff, Ramin Ravan, Florence Leclercq, Pierre-Vladimir Ennezat, Jean Ferrières, Tabassome Simon, Nicolas Danchin

Abstract

Objective: In acute coronary syndromes, switching between thienopyridines is frequent. The aims of the study were to assess the association between switching practices and quality of care.

Methods: Registry study performed in 213 French public university, public non-academic and private hospitals. All consecutive patients admitted for acute myocardial infarction (MI; <48 hours) between 1/10/2010 and 30/11/2010 were eligible. Clinical and biological data were recorded up to 12 months follow-up.

Results: Among 4101 patients receiving thienopyridines, a switch was performed in 868 (21.2%): 678 (16.5%) from clopidogrel to prasugrel and 190 (4.6%) from prasugrel to clopidogrel. Predictors of switch were ST segment elevation MI presentation, admission to a cardiology unit, previous percutaneous coronary intervention, younger age, body weight >60 kg, no history of stroke, cardiac arrest, anaemia or renal dysfunction. In patients with a switch, eligibility for prasugrel was >82% and appropriate use of a switch was 86% from clopidogrel to prasugrel and 20% from prasugrel to clopidogrel. Quality indicators scored higher in the group with a switch and also in centres where the switch rate was higher.

Conclusions: As applied in the French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction (FAST-MI) registry, switching from one P2Y12 inhibitor to another led to a more appropriate prescription and was associated with higher scores on indicators of quality of care.

Figures

Figure 1
Figure 1
Flow chart of the study population according to thienopyridines used in the FAST-MI registry in patients with STEMI and NSTEMI. FAST-MI, French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction; MI, myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction.
Figure 2
Figure 2
Proportion of patients receiving oral antiplatelet agents at each time point (pretreatment, prehospital, admission to 24 hours, 24–48 hours and at discharge).
Figure 3
Figure 3
Forest plot of ORs for the predictors of switch in thienopyridines. STEMI, ST segment elevation myocardial infarction; ED, emergency department; PCI, percutaneous coronary intervention.
Figure 4
Figure 4
Rates of quality indicators across categories of centres (according to the rate of switch). DAPT, dual antiplatelet therapy; betab: β-blockers, ACEI, ACE inhibitors; dis, discharge; composite, composite indicator calculated using opportunity scoring (one point by applicable indicator divided by the number of applicable indicators); composite_st, composite indicator for patients with ST elevation myocardial infarction (including reperfusion within 120 min by primary percutaneous coronary intervention or within 60 min by thrombolysis).

References

    1. Schiele F, Meneveau N. The role of the interventional cardiologist in selecting antiplatelet agents in acute coronary syndromes: a 10-question strategy. Eur Heart J Acute Cardiovasc Care 2012;1:170–6. 10.1177/2048872612450576
    1. Azmoon S, Angiolillo DJ. Switching antiplatelet regimens: alternatives to clopidogrel in patients with acute coronary syndrome undergoing PCI: a review of the literature and practical considerations for the interventional cardiologist. Catheter Cardiovasc Interv 2013;81:232–42. 10.1002/ccd.24480
    1. Bagai A, Peterson ED, Honeycutt E et al. . In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: insights into contemporary practice from the TRANSLATE-ACS study. Eur Heart J Acute Cardiovasc Care 2015;4:499–508. 10.1177/2048872614564082
    1. Bagai A, Wang Y, Wang TY et al. . In-hospital switching between clopidogrel and prasugrel among patients with acute myocardial infarction treated with percutaneous coronary intervention: insights into contemporary practice from the national cardiovascular data registry. Circ Cardiovasc Interv 2014;7:585–93. 10.1161/CIRCINTERVENTIONS.114.001555
    1. Hanssen M, Cottin Y, Khalife K et al. . French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction 2010. FAST-MI 2010. Heart 2012;98:699–705.
    1. Flynn MR, Barrett C, Cosio FG et al. . The Cardiology Audit and Registration Data Standards (CARDS), European data standards for clinical cardiology practice. Eur Heart J 2005;26:308–13. 10.1093/eurheartj/ehi079
    1. Wiviott SD, Braunwald E, McCabe CH et al. . Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001–15. 10.1056/NEJMoa0706482
    1. Roe MT, Armstrong PW, Fox KA et al. . Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med 2012;367:1297–309. 10.1056/NEJMoa1205512
    1. Alexopoulos D, Goudevenos JA, Xanthopoulou I et al. . Implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a report from the GReek AntiPlatelet rEgistry (GRAPE). Int J Cardiol 2013;168:5329–35. 10.1016/j.ijcard.2013.08.007
    1. Payne CD, Li YG, Brandt JT et al. . Switching directly to prasugrel from clopidogrel results in greater inhibition of platelet aggregation in aspirin-treated subjects. Platelets 2008;19:275–81. 10.1080/09537100801891640
    1. Wiviott SD, Trenk D, Frelinger AL et al. . Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 trial. Circulation 2007;116:2923–32. 10.1161/CIRCULATIONAHA.107.740324
    1. Angiolillo DJ, Saucedo JF, Deraad R et al. . Increased platelet inhibition after switching from maintenance clopidogrel to prasugrel in patients with acute coronary syndromes: results of the SWAP (SWitching Anti Platelet) study. J Am Coll Cardiol 2010;56:1017–23. 10.1016/j.jacc.2010.02.072
    1. Montalescot G, Sideris G, Cohen R et al. . Prasugrel compared with high-dose clopidogrel in acute coronary syndrome. The randomised, double-blind ACAPULCO study. Thromb Haemost 2010;103:213–23. 10.1160/TH09-07-0482
    1. Wallentin L, Becker RC, Budaj A et al. . Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045–57. 10.1056/NEJMoa0904327
    1. Hamm CW, Bassand JP, Agewall S et al. . ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999–3054. 10.1093/eurheartj/ehr236
    1. O'Gara PT, Kushner FG, Ascheim DD et al. . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:e362–425. 10.1161/CIR.0b013e3182742cf6
    1. Steg PG, James SK, Atar D et al. . ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012;33:2569–619. 10.1093/eurheartj/ehs215
    1. Wright RS, Anderson JL, Adams CD et al. . 2011 ACCF/AHA focused update of the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;123:2022–60. 10.1161/CIR.0b013e31820f2f3e
    1. Spertus JA, Bonow RO, Chan P et al. . ACCF/AHA new insights into the methodology of performance measurement: a report of the American College of Cardiology Foundation/American Heart Association Task Force on performance measures. Circulation 2010;122:2091–106. 10.1161/CIR.0b013e3181f7d78c
    1. Steg PG, James SK, Atar D et al. . ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619. 10.1093/eurheartj/ehs215
    1. Windecker S, Kolh P, Alfonso F et al. . 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35:2541–619. 10.1093/eurheartj/ehu278

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner