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Long-term antiplatelet therapy in medically managed non-ST-segment elevation acute coronary syndromes: The EPICOR Asia study.
Int J Cardiol. 2020 Nov 10 [Online ahead of print]IJ

Abstract

OBJECTIVES

To describe long-term antithrombotic management patterns (AMPs) in medically managed Asian patients with non-ST-segment myocardial infarction (NSTEMI) or unstable angina (UA).

BACKGROUND

Current guidelines support an early invasive strategy in NSTEMI and UA patients, but many are medically managed, and data are limited on long-term AMPs in Asia.

METHODS

Data were analyzed from medically managed NSTEMI and UA patients included in the prospective, observational EPICOR Asia study (NCT01361386). Survivors to hospital discharge were enrolled (June 2011 to May 2012) from 8 countries/regions across Asia. Baseline characteristics and AMP use up to 2 years post-discharge were collected. Outcomes were major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, and death) and bleeding.

RESULTS

Among 2289 medically managed patients, dual antiplatelet therapy (DAPT) use at discharge was greater in NSTEMI than in UA patients (81.8% vs 65.3%), and was significantly associated with male sex, positive cardiac markers, and prior cardiovascular medications (p < 0.0001). By 2 years, 57.9% and 42.6% of NSTEMI and UA patients, respectively, were on DAPT. On multivariable Cox regression analysis, risk of MACE at 2 years was most significantly associated with older age (HR [95% CI] 1.85 [1.36, 2.50]), diagnosis of NSTEMI vs UA (1.96 [1.47, 2.61]), and chronic renal failure (2.14 [1.34, 3.41]), all p ≤ 0.001. Risk of bleeding was most significantly associated with region (East Asia vs Southeast/South Asia) and diabetes.

CONCLUSIONS

Approximately half of all patients were on DAPT at 2 years. MACE were more frequent in NSTEMI than UA patients during follow-up.

Authors+Show Affiliations

First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, PR China.National Heart Centre Singapore, Singapore.First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.Second Affiliated Hospital of Harbin Medical University, Harbin, PR China.Fuwai Hospital, Xicheng District, Beijing, PR China.Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.General Hospital of Shenyang Military Region, Liaoning, PR China.Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.London School of Hygiene and Tropical Medicine, London, UK.Peking University People's Hospital, Beijing, PR China.AstraZeneca, Beijing, PR China.First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, PR China. Electronic address: zuyiyuan@mail.xjtu.edu.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33186669

Citation

Zhou, Juan, et al. "Long-term Antiplatelet Therapy in Medically Managed non-ST-segment Elevation Acute Coronary Syndromes: the EPICOR Asia Study." International Journal of Cardiology, 2020.
Zhou J, Chin CT, Huang X, et al. Long-term antiplatelet therapy in medically managed non-ST-segment elevation acute coronary syndromes: The EPICOR Asia study. Int J Cardiol. 2020.
Zhou, J., Chin, C. T., Huang, X., Guo, N., Wu, Y., Yu, B., Qiao, S., Chen, J., Han, Y., Ge, J., Pocock, S. J., Huo, Y., Wang, Z., & Yuan, Z. (2020). Long-term antiplatelet therapy in medically managed non-ST-segment elevation acute coronary syndromes: The EPICOR Asia study. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2020.11.015
Zhou J, et al. Long-term Antiplatelet Therapy in Medically Managed non-ST-segment Elevation Acute Coronary Syndromes: the EPICOR Asia Study. Int J Cardiol. 2020 Nov 10; PubMed PMID: 33186669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term antiplatelet therapy in medically managed non-ST-segment elevation acute coronary syndromes: The EPICOR Asia study. AU - Zhou,Juan, AU - Chin,Chee Tang, AU - Huang,Xin, AU - Guo,Ning, AU - Wu,Yue, AU - Yu,Bo, AU - Qiao,Shubin, AU - Chen,Jiyan, AU - Han,Yaling, AU - Ge,Junbo, AU - Pocock,Stuart J, AU - Huo,Yong, AU - Wang,Zhaohong, AU - Yuan,Zuyi, Y1 - 2020/11/10/ PY - 2020/05/20/received PY - 2020/10/27/revised PY - 2020/11/04/accepted PY - 2020/11/14/pubmed PY - 2020/11/14/medline PY - 2020/11/13/entrez KW - Asia KW - Medically managed KW - Non-ST-segment elevation myocardial infarction KW - Unstable angina JF - International journal of cardiology JO - Int J Cardiol N2 - OBJECTIVES: To describe long-term antithrombotic management patterns (AMPs) in medically managed Asian patients with non-ST-segment myocardial infarction (NSTEMI) or unstable angina (UA). BACKGROUND: Current guidelines support an early invasive strategy in NSTEMI and UA patients, but many are medically managed, and data are limited on long-term AMPs in Asia. METHODS: Data were analyzed from medically managed NSTEMI and UA patients included in the prospective, observational EPICOR Asia study (NCT01361386). Survivors to hospital discharge were enrolled (June 2011 to May 2012) from 8 countries/regions across Asia. Baseline characteristics and AMP use up to 2 years post-discharge were collected. Outcomes were major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, and death) and bleeding. RESULTS: Among 2289 medically managed patients, dual antiplatelet therapy (DAPT) use at discharge was greater in NSTEMI than in UA patients (81.8% vs 65.3%), and was significantly associated with male sex, positive cardiac markers, and prior cardiovascular medications (p < 0.0001). By 2 years, 57.9% and 42.6% of NSTEMI and UA patients, respectively, were on DAPT. On multivariable Cox regression analysis, risk of MACE at 2 years was most significantly associated with older age (HR [95% CI] 1.85 [1.36, 2.50]), diagnosis of NSTEMI vs UA (1.96 [1.47, 2.61]), and chronic renal failure (2.14 [1.34, 3.41]), all p ≤ 0.001. Risk of bleeding was most significantly associated with region (East Asia vs Southeast/South Asia) and diabetes. CONCLUSIONS: Approximately half of all patients were on DAPT at 2 years. MACE were more frequent in NSTEMI than UA patients during follow-up. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/33186669/Long_term_antiplatelet_therapy_in_medically_managed_non_ST_segment_elevation_acute_coronary_syndromes:_The_EPICOR_Asia_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(20)34089-4 DB - PRIME DP - Unbound Medicine ER -
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