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Comorbidity and low use of new antiplatelets in acute coronary syndrome
Jaime Aboal1, Isaac Llaó2, Cosme García García3
1Servicio de Cardiología, Hospital Universitari Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain. jaimeaboal@gmail.com.
Insights
Newer P2Y12 inhibitors like ticagrelor and prasugrel are underused in acute NSTE-ACS patients, with comorbidity being a key factor. Lower comorbidity scores predicted the use of these advanced antiplatelet treatments.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- The recommended therapy for acute Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) involves aspirin with new-generation P2Y12 inhibitors (ticagrelor, prasugrel).
- Current clinical use of these advanced P2Y12 inhibitors in NSTE-ACS patients is notably low.
- This underutilization may be linked to patient comorbidity burden.
Purpose of the Study:
- To determine the prevalence of ticagrelor and prasugrel use in NSTE-ACS patients.
- To investigate the association between patient comorbidity and the utilization of these new-generation P2Y12 inhibitors.
Main Methods:
- A multicenter prospective registry involving 8 Cardiac Intensive Care Units.
- Data collected from October 2017 to April 2018 on NSTE-ACS patients.
- Antithrombotic treatment and comorbidity (Charlson Comorbidity Index) were assessed; a multivariate model identified predictors of new P2Y12 inhibitor use.
Main Results:
- 629 NSTE-ACS patients were analyzed; 57.1% received clopidogrel, while 40.6% received ticagrelor or prasugrel.
- Patients with high comorbidity (Charlson Score > 6) predominantly received clopidogrel (82.6%).
- Patients with low comorbidity (Charlson Score 0-1) were more likely to receive ticagrelor or prasugrel (63.6%).
- Independent predictors for new P2Y12 inhibitor use included low Charlson Comorbidity Index, low CRUSADE score, and no history of bleeding.
Conclusions:
- The use of ticagrelor or prasugrel for NSTE-ACS patients remains low.
- Comorbidity, as measured by the Charlson Comorbidity Index, significantly predicts the adoption of new-generation P2Y12 inhibitors in this patient population.
Introduction:
Despite the use of the new generation P2Y12 inhibitors (Ticagrelor and Prasugrel) with aspirin is the recommended therapy in acute NSTE-ACS patients, their current use in clinical practice remains quite low and might be related, among several variables, with increased comorbidity burden. We aimed to assess the prevalence of these treatments and whether their use could be associated with comorbidity.
Method:
A multicentric prospective registry was conducted at 8 Cardiac Intensive Care Units (October 2017-April 2018) in patients admitted with non ST elevation myocardial infarction. Antithrombotic treatment was recorded and the comorbidity risk was assessed using the Charlson Comorbidity Index. We created a multivariate model to identify the independent predictors of the use of new inhibitors of P2Y12.
Results:
A total of 629 patients were included, median age 67 years, 23.2% women, 359 patients (57.1%) treated with clopidogrel and 40.6% with new P2Y12 inhibitors: ticagrelor (228 patients, 36.2%) and prasugrel (30 patients, 4.8%). Among the patients with very high comorbidity (Charlson Score > 6) clopidogrel was the drug of choice (82.6%), meanwhile in patients with low comorbility (Charlson Score 0-1) was the ticagrelor or prasugrel (63.6%). Independent predictors of the use of ticagrelor or prasugrel were a low Charlson Comorbidity Index, a low CRUSADE score and the absence of prior bleeding.
Conclusion:
Antiplatelet treatment with Ticagrelor or Pasugrel was low in patients admitted with NSTE-ACS. Comorbidity calculated with Charlson Comorbidity Index was a powerful predictor of the use of new generation P2Y12 inhibitors in this population.
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