The safety and effectiveness of adenosine diphosphate receptor inhibitor pretreatment among acute myocardial infarction patients treated with percutaneous coronary intervention in community practice: Insights from the TRANSLATE-ACS study.

Abstract

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.

• Authors: Mark B Effron, Tracy Y Wang, Gregg C Fonarow, Timothy D Henry, Marjorie E Zettler, Brian A Baker, Lisa A McCoy, Eric D Peterson
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 91 Issue 2 Pg. 242-250 (02 01 2018) ISSN: 1522-726X [Electronic] United States
• PMID: 28988425 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2017 Wiley Periodicals, Inc.

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Clopidogrel
• Prasugrel Hydrochloride

Topics

• Aged
• Clopidogrel (administration & dosage, adverse effects)
• Community Health Services (trends)
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (blood, diagnosis, mortality, therapy)
• Percutaneous Coronary Intervention (adverse effects, mortality, trends)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Practice Patterns, Physicians' (trends)
• Prasugrel Hydrochloride (administration & dosage, adverse effects)
• Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
• Risk Factors
• ST Elevation Myocardial Infarction (blood, diagnosis, mortality, therapy)
• Time Factors
• Treatment Outcome
• United States