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)

作者：Alexopoulos Dimitrios^*; Goudevenos John A; Xanthopoulou Ioanna; Deftereos Spyridon; Sitafidis George; Kanakakis Ioannis; Hamilos Michalis; Parissis Haralambos; Ntalas Ioannis V; Angelidis Christos; Petousis Stylianos; Vavuranakis Manolis; Hahalis George; Stefanadis Christodoulos

来源：International Journal of Cardiology, 2013, 168(6): 5329-5335.

DOI：10.1016/j.ijcard.2013.08.007

• Acute coronary syndrome
• ST-segment elevation myocardial infarction
• Antiplatelet therapy
• Guideline adherence

Background: Few data exist about the implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). %26lt;br%26gt;Methods: GReek AntiPlatelet rEgistry (GRAPE), initiated on January 2012, is a prospective, observational, multicenter cohort study focusing on contemporary use of P2Y12 inhibitors. In 1434 patients we evaluated appropriateness of P2Y12 selection initially and at discharge by applying an eligibility-assessing algorithm based on P2Y12 inhibitors%26apos; contraindications/specific warnings and precautions. %26lt;br%26gt;Results: Appropriate, less preferable and inappropriate P2Y12 inhibitor selections were made initially in 45.8%, 47.2% and 6.6% and at discharge in 64.1%, 29.2% and 6.6% of patients, respectively. The selection of clopidogrel was most commonly less preferable, both initially (69.7%) and at discharge (75.6%). Appropriate selection of newer agents was high initially (79.2%-82.8%), with further increase as selection at discharge (89.4%-89.8%). Inappropriate selection of the newer agents was 17.2%-20.8% initially, decreasing to 10.2%-10.6% at discharge. Conditions and co-medications related to increased bleeding risk, presentation with ST elevation myocardial infarction and the absence of reperfusion within the first 24 h were themost powerful predictors of appropriate P2Y12 selection initially, whereas age %26gt;= 75 years, conditions and co-medications related to increased bleeding risk and regional trends mostly affected appropriate P2Y12 selection at discharge. %26lt;br%26gt;Conclusions: In GRAPE, adherence with the recently released guidelines on oral antiplatelet therapy was satisfactory. Clopidogrel was most commonly used as a less preferable selection, while prasugrel or ticagrelor selection was mostly appropriate. Certain factors may predict initial and at discharge guideline implementation. Clinical Trial Registration-clinicaltrials. gov Identifier: NCT01774955 http://clinicaltrials.gov/.

• 出版日期2013-10-15