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Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: the Canadian global registry of acute coronary events (GRACE) experience.
Am Heart J. 2009 Dec; 158(6):917-24.AH

Abstract

BACKGROUND

There are limited contemporary data on the early use of clopidogrel or glycoprotein (Gp) IIb/IIIa inhibitors, alone versus combination therapies, in non-ST-elevation acute coronary syndrome (NSTE-ACS).

METHODS

This study included 5,806 Canadian NSTE-ACS patients with elevated cardiac biomarker and/or ST deviation on presentation in the prospective GRACE between 2003-2007. We stratified the study population according to the management strategy (non-invasive vs invasive) and into low-(GRACE risk score <or=108), intermediate- (109-140), and high-risk groups (>or=141).

RESULTS

Overall, 3,893 patients (67.1%) received early (<or=24 hours of admission) antiplatelet therapy; the rates of use were 76%, 73%, and 57% in the low-, intermediate-, and high-risk groups, respectively (P for trend < .001). Only 54% of the conservatively managed patients and 12% of the invasively managed patients received early clopidogrel and GpIIb/IIIa inhibitors, respectively. High-risk patients were less likely (adjusted odds ratio = 0.48, 95% CI 0.39-0.59, P < .001) to receive early clopidogrel or GpIIb/IIIa inhibitors, whereas in-hospital catheterization was an independent positive predictor (adjusted odds ratio = 2.02, 95% CI 1.74-2.34, P < .001) of use.

CONCLUSIONS

In this contemporary NSTE-ACS population, both clopidogrel and GpIIb/IIIa inhibitors were targeted toward patients treated with an invasive strategy but paradoxically toward the lower-risk group. In particular, clopidogrel appeared to be underused among conservatively managed patients despite its proven efficacy, whereas GpIIb/IIIa inhibitors were administered to only a minority of the high-risk patients with elevated cardiac biomarkers. Our findings emphasize the ongoing need to promote the optimal use of evidence-based antiplatelet therapies among high-risk patients with NSTE-ACS.

Authors+Show Affiliations

Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19958857

Citation

Banihashemi, Behnam, et al. "Underutilization of Clopidogrel and Glycoprotein IIb/IIIa Inhibitors in non-ST-elevation Acute Coronary Syndrome Patients: the Canadian Global Registry of Acute Coronary Events (GRACE) Experience." American Heart Journal, vol. 158, no. 6, 2009, pp. 917-24.
Banihashemi B, Goodman SG, Yan RT, et al. Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: the Canadian global registry of acute coronary events (GRACE) experience. Am Heart J. 2009;158(6):917-24.
Banihashemi, B., Goodman, S. G., Yan, R. T., Welsh, R. C., Mehta, S. R., Montalescot, G., Kornder, J. M., Wong, G. C., Gyenes, G., Steg, P. G., & Yan, A. T. (2009). Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: the Canadian global registry of acute coronary events (GRACE) experience. American Heart Journal, 158(6), 917-24. https://doi.org/10.1016/j.ahj.2009.09.016
Banihashemi B, et al. Underutilization of Clopidogrel and Glycoprotein IIb/IIIa Inhibitors in non-ST-elevation Acute Coronary Syndrome Patients: the Canadian Global Registry of Acute Coronary Events (GRACE) Experience. Am Heart J. 2009;158(6):917-24. PubMed PMID: 19958857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: the Canadian global registry of acute coronary events (GRACE) experience. AU - Banihashemi,Behnam, AU - Goodman,Shaun G, AU - Yan,Raymond T, AU - Welsh,Robert C, AU - Mehta,Shamir R, AU - Montalescot,Gilles, AU - Kornder,Jan M, AU - Wong,Graham C, AU - Gyenes,Gabor, AU - Steg,Ph Gabriel, AU - Yan,Andrew T, AU - ,, PY - 2009/06/19/received PY - 2009/09/29/accepted PY - 2009/12/5/entrez PY - 2009/12/5/pubmed PY - 2010/1/7/medline SP - 917 EP - 24 JF - American heart journal JO - Am Heart J VL - 158 IS - 6 N2 - BACKGROUND: There are limited contemporary data on the early use of clopidogrel or glycoprotein (Gp) IIb/IIIa inhibitors, alone versus combination therapies, in non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: This study included 5,806 Canadian NSTE-ACS patients with elevated cardiac biomarker and/or ST deviation on presentation in the prospective GRACE between 2003-2007. We stratified the study population according to the management strategy (non-invasive vs invasive) and into low-(GRACE risk score <or=108), intermediate- (109-140), and high-risk groups (>or=141). RESULTS: Overall, 3,893 patients (67.1%) received early (<or=24 hours of admission) antiplatelet therapy; the rates of use were 76%, 73%, and 57% in the low-, intermediate-, and high-risk groups, respectively (P for trend < .001). Only 54% of the conservatively managed patients and 12% of the invasively managed patients received early clopidogrel and GpIIb/IIIa inhibitors, respectively. High-risk patients were less likely (adjusted odds ratio = 0.48, 95% CI 0.39-0.59, P < .001) to receive early clopidogrel or GpIIb/IIIa inhibitors, whereas in-hospital catheterization was an independent positive predictor (adjusted odds ratio = 2.02, 95% CI 1.74-2.34, P < .001) of use. CONCLUSIONS: In this contemporary NSTE-ACS population, both clopidogrel and GpIIb/IIIa inhibitors were targeted toward patients treated with an invasive strategy but paradoxically toward the lower-risk group. In particular, clopidogrel appeared to be underused among conservatively managed patients despite its proven efficacy, whereas GpIIb/IIIa inhibitors were administered to only a minority of the high-risk patients with elevated cardiac biomarkers. Our findings emphasize the ongoing need to promote the optimal use of evidence-based antiplatelet therapies among high-risk patients with NSTE-ACS. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19958857/Underutilization_of_clopidogrel_and_glycoprotein_IIb/IIIa_inhibitors_in_non_ST_elevation_acute_coronary_syndrome_patients:_the_Canadian_global_registry_of_acute_coronary_events__GRACE__experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00767-4 DB - PRIME DP - Unbound Medicine ER -