Antiplatelet therapy in patients after an acute coronary syndrome: Comparison of the Czech and Slovak Republics Results of the ATHRO registry

Abstract

BackgroundThe modern treatment of acute coronary syndromes includes early initiation of dual antiplatelet therapy (DAPT) and coronary angiography (CAG) followed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Recently two new potent antiplatelet agents (ticagrelor and prasugrel) were introduced in clinical practice. The aim of this registry was to analyze the treatment strategies in two neighboring countries: Czech (CZ) and Slovak (SK) Republics. Patients and methodsA total of 1541 patients was enrolled during one month period in 18 tertiary cardiac centers in CZ (n=1026) and 6 centers in SK (n=515). The mean age was 66±12 years (CZ) vs. 63±12 (SK), diabetes mellitus was present in 31.1% (CZ) and 32.6% (SK). Prior revascularization was reported in 21.9% (CZ) vs. 16.1% (SK). ResultsST-segment elevation myocardial infarction (STEMI) was the final diagnosis in 51.9% (CZ) vs. 44.9% (SK), non-STEMI in 34.1% vs. 31.3% and unstable angina pectoris (UAP) in 14.0% vs. 23.9%. PCI during the initial hospital stay was performed in 83.4% (CZ) vs. 78.8% (SK). The discharge medication included aspirin in 95.3% (both countries), clopidogrel in 75.3% (CZ) vs. 53.6% (SK), ticagrelor in 13.1% (CZ) vs. 17.3% (SK) and prasugrel in 2.6% (CZ) vs. 23.1% (SK). Economic limits were reported to influence the choice of P2Y12 inhibitor in 36.9% (CZ) vs. 23.9% (SK).The indication for ticagrelor was in STEMI 73.9% (CZ) vs. 36.0% (SK), non-STEMI in 20.9% (CZ) vs. 40.4% (SK) and UAP in 5.2% (CZ) vs. 23.6% (SK). The indication for prasugrel was STEMI in 81.5% (CZ) vs. 73.9% (SK), non-STEMI in 18.5% (CZ) vs. 11.8% (SK) and UAP in 0.0% (CZ) vs. 14.3% (SK). ConclusionsThe baseline characteristics of ACS patients are similar in both countries, and the Czech patients tend to be older and have more prior revascularizations. Slovak patients receive more often modern potent P2Y12 inhibitors. The results confirm existing economic barriers preventing full implementation of the antiplatelet recommendations from the current ESC guidelines, but also lack of guidelines knowledge (or implementation) among some physicians.