Mohamed, Mohamed O;
Kontopantelis, Evangelos;
Alasnag, Mirvat;
Abid, Leila;
Banerjee, Amitava;
Sharp, Andrew SP;
Bourantas, Christos;
... Mamas, Mamas A; + view all
(2024)
Impact of Society Guidelines on Trends in Use of Newer P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.
Journal of the American Heart Association
, 13
(9)
, Article e034414. 10.1161/jaha.124.034414.
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Abstract
Background Over the past decade, major society guidelines have recommended the use of newer P2Y12 inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice. Methods and Results All percutaneous coronary intervention procedures (n=534 210) for acute coronary syndrome in England and Wales (April 1, 2010, to March 31, 2022) were retrospectively analyzed, stratified by choice of preprocedural P2Y12 inhibitor (clopidogrel, ticagrelor, and prasugrel). Multivariable logistic regression models were used to examine odds ratios of receipt of ticagrelor and prasugrel (versus clopidogrel) over time, and predictors of their receipt. Overall, there was a significant increase in receipt of newer P2Y12 inhibitors from 2010 to 2020 (2022 versus 2010: ticagrelor odds ratio, 8.12 [95% CI, 7.67–8.60]; prasugrel odds ratio, 6.14 [95% CI, 5.53–6.81]), more so in ST‐segment–elevation myocardial infarction than non–ST‐segment–elevation acute coronary syndrome indication. The most significant increase in odds of receipt of prasugrel was observed between 2020 and 2022 (P<0.001), following a decline/plateau in its use in earlier years (2011–2019). In contrast, the odds of receipt of ticagrelor significantly increased in earlier years (2012–2017, Ptrend<0.001), after which the trend was stable (Ptrend=0.093). Conclusions Over a 13‐year‐period, there has been a significant increase in use of newer P2Y12 inhibitors, although uptake of prasugrel use remained significantly lower than ticagrelor. Earlier society guidelines (pre‐2017) were associated with the highest rates of ticagrelor use for non–ST‐segment–elevation acute coronary syndrome and ST‐segment–elevation myocardial infarction cases while the ISAR‐REACT 5 (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome) trial and later society guidelines were associated with higher prasugrel use, mainly for ST‐segment–elevation myocardial infarction indication.
| Type: | Article |
|---|---|
| Title: | Impact of Society Guidelines on Trends in Use of Newer P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1161/jaha.124.034414 |
| Publisher version: | http://dx.doi.org/10.1161/jaha.124.034414 |
| Language: | English |
| Additional information: | Copyright © 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
| Keywords: | acute coronary syndrome, newer P2Y12 inhibitors,outcomes, percutaneous coronary intervention, trends |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10191800 |
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