Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy

Akshay Bagai; Tracy Y. Wang; Shaun G. Goodman; Harold N. Fisher; Robert C. Welsh; Jean Pierre Dery; Xiang Zhang; Yajun E. Zhu; Asim N. Cheema; Payam Dehghani; Saleem A. Kassam; John Ducas; Neil Brass; Hahn Hoe Kim; Anthony Fung; Erick Schampaert; Ata ur Rehman Quraishi; Shamir R. Mehta

doi:10.1016/j.ijcard.2016.11.240

Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy

Akshay Bagai, Tracy Y. Wang, Shaun G. Goodman, Harold N. Fisher, Robert C. Welsh, Jean Pierre Dery, Xiang Zhang, Yajun E. Zhu, Asim N. Cheema, Payam Dehghani, Saleem A. Kassam, John Ducas, Neil Brass, Hahn Hoe Kim, Anthony Fung, Erick Schampaert, Ata ur Rehman Quraishi, Shamir R. Mehta

Medicine

Résultat de recherche: Article › examen par les pairs

11 Citations (Scopus)

Résumé

Background After myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor inhibitor (ADPri) for at least 1 year. However, whether real-world Canadian practice patterns reflect this recommendation is unknown. Methods We studied 2175 MI patients treated with PCI and discharged from 26 Canadian hospitals between 12/2011 and 05/2013 in the Canadian Observational Antiplatelet sTudy (COAPT). Hierarchical Cox proportional hazard regression modeling was used to determine baseline demographic and clinical factors associated with duration of ADPri therapy post-discharge. Results At index-hospitalization discharge, 1597 (73%) patients were treated with clopidogrel, 220 (10%) with prasugrel, and 358 (17%) with ticagrelor. ADPri was discontinued prior to 1 year in 474 (21.8%) patients; discontinuation rates were lowest for patients discharged on prasugrel (17.7%), compared with clopidogrel (22.5%) or ticagrelor (21.0%), (log rank test, p = 0.03). In addition to regional variability, factors associated with shorter ADPri duration included older age, low body weight, Killip III/IV heart failure, atrial fibrillation, ticagrelor on discharge, and bare metal stent use, while longer ADPri duration was associated with history of prior MI. Conclusions One in five PCI-treated MI patients did not complete Canadian guideline-recommended 1-year course of ADPri treatment. Premature ADPri discontinuation was most strongly associated with factors that increase the risk of bleeding. Further study is required to assess the clinical implications of premature ADPri discontinuation on patient outcomes.

Langue d'origine	English
Pages (de-à)	459-464
Nombre de pages	6
Journal	International Journal of Cardiology
Volume	228
DOI	https://doi.org/10.1016/j.ijcard.2016.11.240
Statut de publication	Published - févr. 1 2017

Note bibliographique

Funding Information:
Dr. Bagai has received speaker's honoraria from AstraZeneca. Dr. Wang has received research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Glaxo Smith Kline, and Regeneron Pharmaceuticals, as well as consulting or honoraria from Astra Zeneca, Eli Lilly, and Premier, Inc. Dr. Goodman has received speaker/consulting honoraria and/or research grant support from Eli Lilly Canada, AstraZeneca, Bristol-Myers Squibb, and Sanofi. Dr. Fisher is a medical officer and has received salary support from Eli Lilly Canada. Dr. Welsh has received research and clinical trial support from Abbott Vascular, Alere, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Canadian Institutes of Health Research, CSL Behring LLC, Edwards Lifesciences, Eli Lilly, Jansen, Johnson and Johnson, Matrizyme Pharma, Pfizer, Population Health Research Institute, University of Alberta Hospital Foundation and honoraria from Astra Zeneca and Bayer. He has participated in the advisory Board for Astra Zeneca, Bayer, Bristol-Myers Squibb/Pfizer.

Funding Information:
Dr. Dery has received speaking and consulting honoraria and/or research grant support from Eli Lilly Canada and AstraZeneca. Dr. Zhang has received salary support from Eli Lilly Co. Ms. Zhu has received salary support from Eli Lilly Co. Dr. Cheema has received research grant support from Eli Lilly Canada. Dr. Deghani has received research grant support from AstraZeneca. Dr. Kassam has received research grant support from Eli Lilly Canada. Dr. Ducas has received research grant support from Eli Lilly Canada. Dr. Brass has received research grant support from Eli Lilly Canada. Dr. Kim has received speaker/consulting fees from AstraZeneca and Eli Lilly and research grant support from Eli Lilly Canada. Dr. Fung has received research grant support from Eli Lilly Canada. Dr. Schampaert has received consulting fee and honoraria from AstraZeneca. Dr. Quraishi has received research grant support from Eli Lilly Canada. Dr. Mehta has received research support from Eli Lilly Canada.

Funding Information:
COAPT was sponsored by Eli Lilly and Company, and Daiichi Sankyo. Site management was performed by the Canadian Heart Research Centre.

Funding Information:
The authors acknowledge editorial assistance by Sue Francis. Dr. Shaun Goodman is supported by the Heart and Stroke Foundation of Ontario in his role as Heart and Stroke Foundation (Polo) Chair at the University of Toronto.

Publisher Copyright:
© 2016 Elsevier Ireland Ltd

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

Accès au document

10.1016/j.ijcard.2016.11.240

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Citer

Bagai, A., Wang, T. Y., Goodman, S. G., Fisher, H. N., Welsh, R. C., Dery, J. P., Zhang, X., Zhu, Y. E., Cheema, A. N., Dehghani, P., Kassam, S. A., Ducas, J., Brass, N., Kim, H. H., Fung, A., Schampaert, E., Quraishi, A. U. R., & Mehta, S. R. (2017). Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy. International Journal of Cardiology, 228, 459-464. https://doi.org/10.1016/j.ijcard.2016.11.240

Bagai, A, Wang, TY, Goodman, SG, Fisher, HN, Welsh, RC, Dery, JP, Zhang, X, Zhu, YE, Cheema, AN, Dehghani, P, Kassam, SA, Ducas, J, Brass, N, Kim, HH, Fung, A, Schampaert, E, Quraishi, AUR & Mehta, SR 2017, 'Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy', International Journal of Cardiology, vol. 228, pp. 459-464. https://doi.org/10.1016/j.ijcard.2016.11.240

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title = "Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy",

abstract = "Background After myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor inhibitor (ADPri) for at least 1 year. However, whether real-world Canadian practice patterns reflect this recommendation is unknown. Methods We studied 2175 MI patients treated with PCI and discharged from 26 Canadian hospitals between 12/2011 and 05/2013 in the Canadian Observational Antiplatelet sTudy (COAPT). Hierarchical Cox proportional hazard regression modeling was used to determine baseline demographic and clinical factors associated with duration of ADPri therapy post-discharge. Results At index-hospitalization discharge, 1597 (73%) patients were treated with clopidogrel, 220 (10%) with prasugrel, and 358 (17%) with ticagrelor. ADPri was discontinued prior to 1 year in 474 (21.8%) patients; discontinuation rates were lowest for patients discharged on prasugrel (17.7%), compared with clopidogrel (22.5%) or ticagrelor (21.0%), (log rank test, p = 0.03). In addition to regional variability, factors associated with shorter ADPri duration included older age, low body weight, Killip III/IV heart failure, atrial fibrillation, ticagrelor on discharge, and bare metal stent use, while longer ADPri duration was associated with history of prior MI. Conclusions One in five PCI-treated MI patients did not complete Canadian guideline-recommended 1-year course of ADPri treatment. Premature ADPri discontinuation was most strongly associated with factors that increase the risk of bleeding. Further study is required to assess the clinical implications of premature ADPri discontinuation on patient outcomes.",

author = "Akshay Bagai and Wang, {Tracy Y.} and Goodman, {Shaun G.} and Fisher, {Harold N.} and Welsh, {Robert C.} and Dery, {Jean Pierre} and Xiang Zhang and Zhu, {Yajun E.} and Cheema, {Asim N.} and Payam Dehghani and Kassam, {Saleem A.} and John Ducas and Neil Brass and Kim, {Hahn Hoe} and Anthony Fung and Erick Schampaert and Quraishi, {Ata ur Rehman} and Mehta, {Shamir R.}",

note = "Funding Information: Dr. Bagai has received speaker's honoraria from AstraZeneca. Dr. Wang has received research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Glaxo Smith Kline, and Regeneron Pharmaceuticals, as well as consulting or honoraria from Astra Zeneca, Eli Lilly, and Premier, Inc. Dr. Goodman has received speaker/consulting honoraria and/or research grant support from Eli Lilly Canada, AstraZeneca, Bristol-Myers Squibb, and Sanofi. Dr. Fisher is a medical officer and has received salary support from Eli Lilly Canada. Dr. Welsh has received research and clinical trial support from Abbott Vascular, Alere, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Canadian Institutes of Health Research, CSL Behring LLC, Edwards Lifesciences, Eli Lilly, Jansen, Johnson and Johnson, Matrizyme Pharma, Pfizer, Population Health Research Institute, University of Alberta Hospital Foundation and honoraria from Astra Zeneca and Bayer. He has participated in the advisory Board for Astra Zeneca, Bayer, Bristol-Myers Squibb/Pfizer. Funding Information: Dr. Dery has received speaking and consulting honoraria and/or research grant support from Eli Lilly Canada and AstraZeneca. Dr. Zhang has received salary support from Eli Lilly Co. Ms. Zhu has received salary support from Eli Lilly Co. Dr. Cheema has received research grant support from Eli Lilly Canada. Dr. Deghani has received research grant support from AstraZeneca. Dr. Kassam has received research grant support from Eli Lilly Canada. Dr. Ducas has received research grant support from Eli Lilly Canada. Dr. Brass has received research grant support from Eli Lilly Canada. Dr. Kim has received speaker/consulting fees from AstraZeneca and Eli Lilly and research grant support from Eli Lilly Canada. Dr. Fung has received research grant support from Eli Lilly Canada. Dr. Schampaert has received consulting fee and honoraria from AstraZeneca. Dr. Quraishi has received research grant support from Eli Lilly Canada. Dr. Mehta has received research support from Eli Lilly Canada. Funding Information: COAPT was sponsored by Eli Lilly and Company, and Daiichi Sankyo. Site management was performed by the Canadian Heart Research Centre. Funding Information: The authors acknowledge editorial assistance by Sue Francis. Dr. Shaun Goodman is supported by the Heart and Stroke Foundation of Ontario in his role as Heart and Stroke Foundation (Polo) Chair at the University of Toronto. Publisher Copyright: {\textcopyright} 2016 Elsevier Ireland Ltd",

year = "2017",

month = feb,

day = "1",

doi = "10.1016/j.ijcard.2016.11.240",

language = "English",

volume = "228",

pages = "459--464",

journal = "International Journal of Cardiology",

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TY - JOUR

T1 - Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction

T2 - Insights from the Canadian Observational AntiPlatelet sTudy

AU - Bagai, Akshay

AU - Wang, Tracy Y.

AU - Goodman, Shaun G.

AU - Fisher, Harold N.

AU - Welsh, Robert C.

AU - Dery, Jean Pierre

AU - Zhang, Xiang

AU - Zhu, Yajun E.

AU - Cheema, Asim N.

AU - Dehghani, Payam

AU - Kassam, Saleem A.

AU - Ducas, John

AU - Brass, Neil

AU - Kim, Hahn Hoe

AU - Fung, Anthony

AU - Schampaert, Erick

AU - Quraishi, Ata ur Rehman

AU - Mehta, Shamir R.

N1 - Funding Information: Dr. Bagai has received speaker's honoraria from AstraZeneca. Dr. Wang has received research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Glaxo Smith Kline, and Regeneron Pharmaceuticals, as well as consulting or honoraria from Astra Zeneca, Eli Lilly, and Premier, Inc. Dr. Goodman has received speaker/consulting honoraria and/or research grant support from Eli Lilly Canada, AstraZeneca, Bristol-Myers Squibb, and Sanofi. Dr. Fisher is a medical officer and has received salary support from Eli Lilly Canada. Dr. Welsh has received research and clinical trial support from Abbott Vascular, Alere, Astra Zeneca, Bayer, BMS, Boehringer Ingelheim, Canadian Institutes of Health Research, CSL Behring LLC, Edwards Lifesciences, Eli Lilly, Jansen, Johnson and Johnson, Matrizyme Pharma, Pfizer, Population Health Research Institute, University of Alberta Hospital Foundation and honoraria from Astra Zeneca and Bayer. He has participated in the advisory Board for Astra Zeneca, Bayer, Bristol-Myers Squibb/Pfizer. Funding Information: Dr. Dery has received speaking and consulting honoraria and/or research grant support from Eli Lilly Canada and AstraZeneca. Dr. Zhang has received salary support from Eli Lilly Co. Ms. Zhu has received salary support from Eli Lilly Co. Dr. Cheema has received research grant support from Eli Lilly Canada. Dr. Deghani has received research grant support from AstraZeneca. Dr. Kassam has received research grant support from Eli Lilly Canada. Dr. Ducas has received research grant support from Eli Lilly Canada. Dr. Brass has received research grant support from Eli Lilly Canada. Dr. Kim has received speaker/consulting fees from AstraZeneca and Eli Lilly and research grant support from Eli Lilly Canada. Dr. Fung has received research grant support from Eli Lilly Canada. Dr. Schampaert has received consulting fee and honoraria from AstraZeneca. Dr. Quraishi has received research grant support from Eli Lilly Canada. Dr. Mehta has received research support from Eli Lilly Canada. Funding Information: COAPT was sponsored by Eli Lilly and Company, and Daiichi Sankyo. Site management was performed by the Canadian Heart Research Centre. Funding Information: The authors acknowledge editorial assistance by Sue Francis. Dr. Shaun Goodman is supported by the Heart and Stroke Foundation of Ontario in his role as Heart and Stroke Foundation (Polo) Chair at the University of Toronto. Publisher Copyright: © 2016 Elsevier Ireland Ltd

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background After myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor inhibitor (ADPri) for at least 1 year. However, whether real-world Canadian practice patterns reflect this recommendation is unknown. Methods We studied 2175 MI patients treated with PCI and discharged from 26 Canadian hospitals between 12/2011 and 05/2013 in the Canadian Observational Antiplatelet sTudy (COAPT). Hierarchical Cox proportional hazard regression modeling was used to determine baseline demographic and clinical factors associated with duration of ADPri therapy post-discharge. Results At index-hospitalization discharge, 1597 (73%) patients were treated with clopidogrel, 220 (10%) with prasugrel, and 358 (17%) with ticagrelor. ADPri was discontinued prior to 1 year in 474 (21.8%) patients; discontinuation rates were lowest for patients discharged on prasugrel (17.7%), compared with clopidogrel (22.5%) or ticagrelor (21.0%), (log rank test, p = 0.03). In addition to regional variability, factors associated with shorter ADPri duration included older age, low body weight, Killip III/IV heart failure, atrial fibrillation, ticagrelor on discharge, and bare metal stent use, while longer ADPri duration was associated with history of prior MI. Conclusions One in five PCI-treated MI patients did not complete Canadian guideline-recommended 1-year course of ADPri treatment. Premature ADPri discontinuation was most strongly associated with factors that increase the risk of bleeding. Further study is required to assess the clinical implications of premature ADPri discontinuation on patient outcomes.

AB - Background After myocardial infarction (MI) treated with percutaneous coronary intervention (PCI), guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor inhibitor (ADPri) for at least 1 year. However, whether real-world Canadian practice patterns reflect this recommendation is unknown. Methods We studied 2175 MI patients treated with PCI and discharged from 26 Canadian hospitals between 12/2011 and 05/2013 in the Canadian Observational Antiplatelet sTudy (COAPT). Hierarchical Cox proportional hazard regression modeling was used to determine baseline demographic and clinical factors associated with duration of ADPri therapy post-discharge. Results At index-hospitalization discharge, 1597 (73%) patients were treated with clopidogrel, 220 (10%) with prasugrel, and 358 (17%) with ticagrelor. ADPri was discontinued prior to 1 year in 474 (21.8%) patients; discontinuation rates were lowest for patients discharged on prasugrel (17.7%), compared with clopidogrel (22.5%) or ticagrelor (21.0%), (log rank test, p = 0.03). In addition to regional variability, factors associated with shorter ADPri duration included older age, low body weight, Killip III/IV heart failure, atrial fibrillation, ticagrelor on discharge, and bare metal stent use, while longer ADPri duration was associated with history of prior MI. Conclusions One in five PCI-treated MI patients did not complete Canadian guideline-recommended 1-year course of ADPri treatment. Premature ADPri discontinuation was most strongly associated with factors that increase the risk of bleeding. Further study is required to assess the clinical implications of premature ADPri discontinuation on patient outcomes.

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Longitudinal treatment patterns with ADP receptor inhibitors after myocardial infarction: Insights from the Canadian Observational AntiPlatelet sTudy

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