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Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study.
Indian Heart J. 2019 Jan - Feb; 71(1):25-31.IH

Abstract

BACKGROUND

Acute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study.

METHODS

EPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns.

RESULTS

EPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients.

CONCLUSION

This study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI.

Authors+Show Affiliations

Sir Ganga Ram Hospital, Delhi, India. Electronic address: jpssawhney@yahoo.com.Madras Medical Mission, Chennai, India.B.M.Birla Heart Research Center, Kolkata, India.G. B. Pant Hospital, Delhi, India.PRS Hospital, Trivandrum, India.Escorts Heart Institute, Delhi, India.Ruby Hospital, Pune, India.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

31000179

Citation

Sawhney, J P S., et al. "Short- and Long-term Follow-up of Antithrombotic Management Patterns in Patients Hospitalized With Acute Coronary Syndrome: Indian Subgroup of EPICOR Asia Study." Indian Heart Journal, vol. 71, no. 1, 2019, pp. 25-31.
Sawhney JPS, Mullasari A, Kahali D, et al. Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study. Indian Heart J. 2019;71(1):25-31.
Sawhney, J. P. S., Mullasari, A., Kahali, D., Mehta, V., Nair, T., Kaul, U., & Hirematth, M. S. (2019). Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study. Indian Heart Journal, 71(1), 25-31. https://doi.org/10.1016/j.ihj.2018.12.005
Sawhney JPS, et al. Short- and Long-term Follow-up of Antithrombotic Management Patterns in Patients Hospitalized With Acute Coronary Syndrome: Indian Subgroup of EPICOR Asia Study. Indian Heart J. 2019 Jan - Feb;71(1):25-31. PubMed PMID: 31000179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study. AU - Sawhney,J P S, AU - Mullasari,Ajit, AU - Kahali,Dhiman, AU - Mehta,Vimal, AU - Nair,Tiny, AU - Kaul,Upendra, AU - Hirematth,M S, Y1 - 2019/01/03/ PY - 2018/05/24/received PY - 2018/11/14/revised PY - 2018/12/26/accepted PY - 2019/4/20/entrez PY - 2019/4/20/pubmed PY - 2019/9/5/medline KW - ACS KW - Antithrombotic KW - DAPT KW - EPICOR- India KW - Myocardial infarction KW - NSTEMI KW - STEMI SP - 25 EP - 31 JF - Indian heart journal JO - Indian Heart J VL - 71 IS - 1 N2 - BACKGROUND: Acute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study. METHODS: EPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns. RESULTS: EPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients. CONCLUSION: This study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI. SN - 2213-3763 UR - https://www.unboundmedicine.com/medline/citation/31000179/Short__and_long_term_follow_up_of_antithrombotic_management_patterns_in_patients_hospitalized_with_acute_coronary_syndrome:_Indian_subgroup_of_EPICOR_Asia_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0019-4832(18)30357-2 DB - PRIME DP - Unbound Medicine ER -