TY - JOUR
T1 - The safety and effectiveness of adenosine diphosphate receptor inhibitor pretreatment among acute myocardial infarction patients treated with percutaneous coronary intervention in community practice
T2 - Insights from the TRANSLATE-ACS study
AU - Effron, Mark B.
AU - Wang, Tracy Y.
AU - Fonarow, Gregg C.
AU - Henry, Timothy D.
AU - Zettler, Marjorie E.
AU - Baker, Brian A.
AU - McCoy, Lisa A.
AU - Peterson, Eric D.
N1 - Funding Information:
TY Wang: Dr. Wang reports research grant support: Eli Lilly and Company, Daiichi Sankyo, Astra Zeneca; Bristol Myers Squibb, Boston Scientific, Gilead, Glaxo Smith Kline, Regeneron; consulting services: Eli Lilly and Company, Astra Zeneca; Premier.
Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Objectives: To understand the optimal timing of adenosine diphosphate (ADP) receptor inhibitor pretreatment prior to percutaneous coronary intervention (PCI) among acute myocardial infarction (MI) patients. Background: The role of ADP receptor inhibitor pretreatment in this population is unclear. Methods: A total of 9,251 ADP receptor inhibitor-naïve MI patients undergoing PCI at 229 TRANSLATE-ACS sites were evaluated. Adjusted risks of in-hospital major adverse cardiovascular events (MACE) and major bleeding were compared among patients with and without pretreatment using inverse probability-weighted propensity adjustment. Results: Of 9,251 patients treated with either prasugrel or clopidogrel during the index MI hospitalization, 4,056 (44%) received pretreatment (ST-segment elevation MI [STEMI] 54.9%, non-STEMI 45.1%); pretreatment was used more commonly among those receiving clopidogrel than prasugrel (52% vs. 20%, P < 0.0001). MACE risks were not significantly different between patients with and without pretreatment (clopidogrel 2.1% vs. 2.2%, adjusted hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.70–1.43; prasugrel 2.1% vs. 2.3%, adjusted odds ratio [OR] 0.82, 95% CI 0.42–1.60). No differences in major bleeding were observed among those receiving versus not receiving pretreatment (clopidogrel 3.1% vs. 3.5%, adjusted HR 0.94, 95% CI 0.65–1.36; prasugrel 2.5% vs. 2.7%, adjusted OR 0.93, 95% CI 0.42–2.02); results were similar when stratified by MI type. Conclusions: ADP receptor inhibitor pretreatment (44%) is commonly used among acute MI patients undergoing PCI in contemporary practice, but no significant differences were found in in-hospital MACE and/or bleeding risks between patients receiving versus not receiving pretreatment, regardless of ADP receptor inhibitor type.
AB - Objectives: To understand the optimal timing of adenosine diphosphate (ADP) receptor inhibitor pretreatment prior to percutaneous coronary intervention (PCI) among acute myocardial infarction (MI) patients. Background: The role of ADP receptor inhibitor pretreatment in this population is unclear. Methods: A total of 9,251 ADP receptor inhibitor-naïve MI patients undergoing PCI at 229 TRANSLATE-ACS sites were evaluated. Adjusted risks of in-hospital major adverse cardiovascular events (MACE) and major bleeding were compared among patients with and without pretreatment using inverse probability-weighted propensity adjustment. Results: Of 9,251 patients treated with either prasugrel or clopidogrel during the index MI hospitalization, 4,056 (44%) received pretreatment (ST-segment elevation MI [STEMI] 54.9%, non-STEMI 45.1%); pretreatment was used more commonly among those receiving clopidogrel than prasugrel (52% vs. 20%, P < 0.0001). MACE risks were not significantly different between patients with and without pretreatment (clopidogrel 2.1% vs. 2.2%, adjusted hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.70–1.43; prasugrel 2.1% vs. 2.3%, adjusted odds ratio [OR] 0.82, 95% CI 0.42–1.60). No differences in major bleeding were observed among those receiving versus not receiving pretreatment (clopidogrel 3.1% vs. 3.5%, adjusted HR 0.94, 95% CI 0.65–1.36; prasugrel 2.5% vs. 2.7%, adjusted OR 0.93, 95% CI 0.42–2.02); results were similar when stratified by MI type. Conclusions: ADP receptor inhibitor pretreatment (44%) is commonly used among acute MI patients undergoing PCI in contemporary practice, but no significant differences were found in in-hospital MACE and/or bleeding risks between patients receiving versus not receiving pretreatment, regardless of ADP receptor inhibitor type.
KW - acute myocardial infarction
KW - adenosine diphosphate receptor inhibitor pretreatment
KW - bleeding risk
KW - major adverse cardiac events
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.27145
DO - 10.1002/ccd.27145
M3 - Article
C2 - 28988425
AN - SCOPUS:85030650168
SN - 1522-1946
VL - 91
SP - 242
EP - 250
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -