PATTERNS OF ADP RECEPTOR INHIBITOR USE DURING THE INDEX HOSPITALIZATION IN PATIENTS WITH MYOCARDIAL INFARCTION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE CANADIAN OBSERVATIONAL ANTIPLATELET STUDY (COAPT)

Abstract

adenosine diphosphate (ADP) receptor inhibitors (ticagrelor, prasugrel), ischemic outcomes and bleeding risks of Canadian patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) in routine practice have not been fully characterized. METHODS: COAPT is a prospective, multicenter, longitudinal, observational cohort study describing Canadian treatment patterns of ADP receptor inhibitor (ADPri) therapy and its association with patient and treatment characteristics, over a 15-month period, in patients with ST elevation (STEMI) and non-ST elevation MI (NSTEMI) undergoing PCI. We investigated the patterns of use of ADPri therapy in-hospital and longer-term ischemic and bleeding events in this population. For this interim analysis (follow-up to be completed in Q3 2014), major adverse cardiovascular events (MACE: death, MI, stroke, urgent revascularization, stent thrombosis, cardiogenic shock, and new or worsening congestive heart failure [CHF]) and moderate/severe bleeding were identified during prospective follow-up. RESULTS: Between December 2011 andMay 2013, 2134 patients (61% STEMI), were enrolled from 26 PCI hospitals. Patient characteristics are shown in Table 1. Aspirin was given to 93% of patients on initial presentation (median dose 160 mg). Discharge ADPri therapy was clopidogrel (73%), ticagrelor (17%), and prasugrel (10%); 2.3% received oral anticoagulation at discharge. Inhospital MACE occurred in 11.1% of patients, including death (0.1%), MI (6.9%), stroke (0.2%), urgent revascularization (4.6%), stent thrombosis (0.7%), cardiogenic shock (1.0%), and new or worsening CHF (3.7%). During a mean follow-up of 11.7 months, MACE occurred in 6% of patients after discharge. Figure 1 shows the percentage of patients with cardiovascular events by discharge ADPri therapy. Moderate/severe bleeding was reported in 1.4% of patients in-hospital and 5% after discharge. Most frequent sites of bleeding were nose (6.8%), gastrointestinal (3.2%), hematoma/ vascular access site (3.8%), and urinary tract (1.7%). Approximately 1.0% received a blood transfusion, and 0.6% underwent a surgical procedure for bleeding. ADPri were switched, interrupted, or discontinued due to concomitant oral anticoagulants in 0.6%, 0.1%, or 0.6%, respectively. Overall, 1.6% required stopping the ADPri. CONCLUSION: In this observational study where newer ADPri therapies were prescribed to onlyw27% of patients at discharge, MACE occurred in 6% and moderate/severe bleeding occurred in 5% of patients in the year post-discharge. In accordance with the 2012 Updated Canadian Cardiovascular Society Antiplatelet Therapy Guideline recommendations for the year following discharge, there may be an opportunity to further reduce MACE with greater use of newer ADPri agents. Eli Lilly Canada Inc.