Patterns of Upstream Antiplatelet Therapy Use Before Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction (from the CRUSADE National Quality Improvement Initiative)

Deepu Alexander, Noelle Mann, Fang-Shu Ou, Eric D. Peterson, E. Magnus Ohman, W. Brian Gibler, Matthew T. Roe

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

We sought to determine the usage patterns and impact of upstream glycoprotein IIb/IIIa inhibitor and clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We studied trends in the use of upstream glycoprotein IIb/IIIa inhibitors and clopidogrel in 3,895 patients with STEMI undergoing primary PCI at 124 hospitals in the United States participating in the CRUSADE initiative from March 2005 to December 2006. Administration of these agents >15 minutes before PCI was considered pre-PCI use, and administration ≤15 minutes before, during, and after PCI was considered peri-PCI use. A total of 3,566 patients (91.6%) received glycoprotein IIb/IIIa inhibitors within 24 hours of presentation, of whom 1,225 (34.4%) received this medication before PCI. Similarly, 3,785 patients (97.2%) received clopidogrel within 24 hours of presentation, of whom 1,029 (27.2%) received this medication before PCI. From 2005 to 2006, pre-PCI glycoprotein IIb/IIIa inhibitor use decreased from 43.4% to 33.5%, whereas pre-PCI clopidogrel use increased from 21.2% to 31.5%. Clinical characteristics, risk of adverse outcomes, and bleeding events were similar in the pre- versus peri-PCI glycoprotein IIb/IIIa inhibitor and clopidogrel cohorts, respectively. In conclusion, most patients with STEMI undergoing primary PCI receive glycoprotein IIb/IIIa inhibitors and clopidogrel, but only 1/3 are treated upstream with these agents and this upstream use does not have a significant impact on outcomes. These results indicate that further studies are needed to determine the optimal dosing and timing of antiplatelet therapies for patients undergoing primary PCI.

Original languageEnglish (US)
Pages (from-to)1335-1340
Number of pages6
JournalAmerican Journal of Cardiology
Volume102
Issue number10
DOIs
StatePublished - Nov 15 2008
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
clopidogrel
Quality Improvement
Platelet Glycoprotein GPIIb-IIIa Complex
Therapeutics
ST Elevation Myocardial Infarction
Myocardial Infarction
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Patterns of Upstream Antiplatelet Therapy Use Before Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction (from the CRUSADE National Quality Improvement Initiative). / Alexander, Deepu; Mann, Noelle; Ou, Fang-Shu; Peterson, Eric D.; Ohman, E. Magnus; Gibler, W. Brian; Roe, Matthew T.

In: American Journal of Cardiology, Vol. 102, No. 10, 15.11.2008, p. 1335-1340.

Research output: Contribution to journalArticle

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abstract = "We sought to determine the usage patterns and impact of upstream glycoprotein IIb/IIIa inhibitor and clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We studied trends in the use of upstream glycoprotein IIb/IIIa inhibitors and clopidogrel in 3,895 patients with STEMI undergoing primary PCI at 124 hospitals in the United States participating in the CRUSADE initiative from March 2005 to December 2006. Administration of these agents >15 minutes before PCI was considered pre-PCI use, and administration ≤15 minutes before, during, and after PCI was considered peri-PCI use. A total of 3,566 patients (91.6{\%}) received glycoprotein IIb/IIIa inhibitors within 24 hours of presentation, of whom 1,225 (34.4{\%}) received this medication before PCI. Similarly, 3,785 patients (97.2{\%}) received clopidogrel within 24 hours of presentation, of whom 1,029 (27.2{\%}) received this medication before PCI. From 2005 to 2006, pre-PCI glycoprotein IIb/IIIa inhibitor use decreased from 43.4{\%} to 33.5{\%}, whereas pre-PCI clopidogrel use increased from 21.2{\%} to 31.5{\%}. Clinical characteristics, risk of adverse outcomes, and bleeding events were similar in the pre- versus peri-PCI glycoprotein IIb/IIIa inhibitor and clopidogrel cohorts, respectively. In conclusion, most patients with STEMI undergoing primary PCI receive glycoprotein IIb/IIIa inhibitors and clopidogrel, but only 1/3 are treated upstream with these agents and this upstream use does not have a significant impact on outcomes. These results indicate that further studies are needed to determine the optimal dosing and timing of antiplatelet therapies for patients undergoing primary PCI.",
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