Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry.
Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry.
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DOI：
10.1161/jaha.117.008125
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发表时间：
2018-06-09
影响因子：
5.4
通讯作者：
Jneid H
中科院分区：
文献类型：
--
作者：
Basra SS;Wang TY;Simon DN;Chiswell K;Virani SS;Alam M;Nambi V;Denktas AE;Deswal A;Bozkurt B;Ballantyne CM;Peterson ED;Jneid H
替格瑞洛是一种 P2Y12 受体抑制剂，与氯吡格雷相比，临床疗效更佳。然而，与大剂量阿司匹林合用时，其疗效会降低。该研究纳入了 2013 年 10 月至 2014 年 12 月急性冠脉治疗和干预结果网络 (ACTION) 登记处 - 遵循指南 (GWTG) 中患有急性心肌梗死的患者（167 455 名患者；622 个地点）。我们评估了 P2Y12 抑制剂处方的时间趋势，并确定了与出院时使用替格瑞洛相关的因素。在出院时服用替格瑞洛和阿司匹林的患者（21262 名患者）中，我们评估了出院时与大剂量阿司匹林处方相关的时间趋势和独立因素。出院时替格瑞洛处方量显着增加，从 12% 增加至 16.7% (P<0.0001)。出院时普拉格雷和氯吡格雷的使用量也有所减少（分别为 15.7%–13.9% 和 54.2%–51.1%，P<0.0001）。与出院时优先服用替格瑞洛处方而非氯吡格雷相关的独立因素包括年龄较小、白种人、家庭替格瑞洛使用、侵入性治疗、院内再梗死和卒中（所有因素均 P<0.0001），而年龄较大、女性、既往卒中、家庭替格瑞洛使用和院内卒中（所有因素均 P<0.0001）与出院时优先服用替格瑞洛处方相关。普拉格雷。 3.1% 因替格瑞洛出院的患者使用了大剂量阿司匹林。与出院时服用大剂量阿司匹林相关的独立因素包括家庭使用阿司匹林、糖尿病、既往心肌梗死、既往冠状动脉搭桥术、ST段抬高型心肌梗死、心源性休克和地理区域（P=0.01）。我们当代的分析显示，替格瑞洛的使用略有增加，但出院时坚持使用小剂量阿司匹林的比例很高。
Ticagrelor is a P2Y12 receptor inhibitor with superior clinical efficacy compared with clopidogrel. However, it is associated with reduced efficacy when combined with a high‐dose aspirin. Patients in the acute coronary treatment and intervention outcomes network (ACTION) Registry‐Get With The Guidelines (GWTG) with acute myocardial infarction from October 2013 through December 2014 were included in the study (167 455 patients; 622 sites). We evaluated temporal trends in the prescription of P2Y12 inhibitors, and identified factors associated with ticagrelor use at discharge. Among patients discharged on ticagrelor and aspirin (21 262 patients), we evaluated the temporal trends and independent factors associated with high‐dose aspirin prescription at discharge. Ticagrelor prescription at discharge increased significantly from 12% to 16.7% (P<0.0001). Decreases in prasugrel and clopidogrel use at discharge (15.7%–13.9% and 54.2%–51.1%, respectively, P<0.0001) were also observed. Independent factors associated with preferential ticagrelor prescription at discharge over clopidogrel included younger age, white race, home ticagrelor use, invasive management, and in‐hospital re‐infarction and stroke (P<0.0001 for all), whereas older age, female sex, prior stroke, home ticagrelor use, and in‐hospital stroke (P<0.0001 for all) were associated with preferential ticagrelor prescription at discharge over prasugrel. High‐dose aspirin was used in 3.1% of patients discharged on ticagrelor. Independent factors associated with high‐dose aspirin prescription at discharge included home aspirin use, diabetes mellitus, previous myocardial infarction, previous coronary artery bypass graft, ST‐segment–elevation myocardial infarction, cardiogenic shock, and geographic region (P=0.01). Our contemporary analysis shows a modest but significant increase in the use of ticagrelor and a high rate of adherence to the use of low‐dose aspirin at discharge.