Current use of antiplatelet therapy in the management of acute myocardial infarction: overview of the FRENCHIE national registry

Abstract

Abstract Background There are many options for antiplatelet therapy (APT) at various stages in the management of acute myocardial infarction (MI) but few contemporary data regarding use in routine clinical practice in unselected patients. Purpose to describe the contemporary use of APT treatments in unselected MI patients. Methods FRENCHIE (FRENch CoHort of myocardial Infarction Evaluation) is a multicenter observational study (38 centers in France) consecutively enrolling patients with spontaneous MI whose symptoms were < 48 hours. Exclusion criteria were age < 18 years, no health coverage, unstable angina and procedure-related MI. Results Between September 2019 and December 2020, 10190 patients with MI were enrolled. Complete data on APT use were available for 9842 patients. Of these, 54.5% had ST elevation myocardial infarction (STEMI) and 45.5% non-STEMI (NSTEMI). During the first 24 hours, APT use for STEMI and NSTEMI patients, was as follows, respectively: acetylsalicylic acid (ASA) 95.1% and 88.8%, clopidogrel 12.4% and 17.7%, ticagrelor 79.5% and 55.0%, prasugrel 4.8% and 3.6%, GPIIb-IIIa inhibitors 23.8% and 6.5%, Cangrelor 1.1% and 0.8%. Among STEMI patients, 3.2% had undergone thrombolysis, 92.2% primary percutaneous coronary intervention (pPCI) and 4.5% did not have reperfusion during acute phase management. The use of ASA was similar regardless of the initial reperfusion strategy, but that of P2Y12 inhibitors (P2Y12i) was different. Clopidogrel was mainly used in case of thrombolysis, 69.6% of cases, while ticagrelor was mainly used in case of pPCI or medical treatment alone, respectively in 83.9% and 59.7% of cases. GPIIb-IIIa inhibitors were used in 9.3%, 26.2% and 11.4% in patients who had undergone thrombolysis, pCI and medical treatment respectively. At hospital discharge, APT use was as follows, respectively for STEMI and NSTEMI patients: ASA 94.6% and 91.2%, clopidogrel 14.7% and 21.8%, ticagrelor 72.6% and 54.9%, prasugrel 6.9% and 5.7%. The first P2Y12i administered was different from that retained at discharge in 15.4% of STEMI and 12.5% of NSTEMI patients. The most common scenario was switching from ticagrelor to clopidogrel in 64.2% of STEMI patients and 57.2% of NSTEMI patients. No P2Y12i was prescribed at discharge in 3.6% of STEMI patients and 11.3% of NSTEMI patients. Conclusion In contemporary practice in France, P2Y12i use was different according to MI type and to initial reperfusion strategy. GPIIb-IIIa inhibitors were used in more than a quarter of STEMI patients with pPCI. Switching between P2Y12i occurred in 1/8 of patients before discharge and deserves further investigation.