Treatment patterns in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Abstract

Background:

The Antiplatelet Therapy Observational Registry (APTOR) is a prospective observational study of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a ‘real world’ clinical setting. Here the authors report on the management of ACS patients in three European countries during the hospital phase and through 12-months’ follow-up, including use of antiplatelet agents, co-medications and stents, as well as clinical outcomes at 12 months.

Methods:

ACS patients undergoing PCI (N = 1525) from January to August 2007 were planned to be consecutively recruited in France, Spain and the UK.

Results:

Index diagnosis was unstable angina/non-ST-segment elevation myocardial infarction (MI) in 62% and ST-segment elevation MI in 38%. Prior to the index ACS event, 17% were prescribed both aspirin and clopidogrel. While in-hospital clopidogrel and aspirin use was similar across countries, considerable variation was observed between countries at 12 months (clopidogrel 66–75%; aspirin 86–95%). The UK most frequently used a 300-mg clopidogrel loading dose (70%) compared with France (53%) and Spain (56%), while >300 mg was used in 21%, 34% and 16% patients, respectively. Bare metal stents only were used in 42% of subjects, drug-eluting stents (DES) only in 40%, and both in 10%, with the highest rates of DES use in Spain (70%) followed by the UK (47%) and France (31%). The composite endpoint of cardiovascular (CV) death, MI or stroke occurred in 4.7% of patients by 12 months.

Conclusions:

APTOR shows marked variation in ACS management between countries in antiplatelet therapy, co-medications and stent use. Due to the observational design of the registry, statistical testing was not applied and data should be seen as hypothesis generating. These data provide a useful benchmark for comparison with current guidelines.

Key words::

• Acute coronary syndrome
• Antiplatelet therapy
• Bare metal stent
• Clinical outcomes
• Drug eluting stent
• Percutaneous coronary intervention

Transparency

Declaration of funding

APTOR was funded by Daiichi Sankyo Company, Ltd and Eli Lilly and Company.

Declaration of financial/other relationships

C.S., M.S. and M.B. have disclosed that they are employees of Lilly. J.F. has disclosed that he received grant support from sanofi-aventis, Bristol-Myers Squibb and Pfizer. U.Z. has disclosed that he has received research grant support and speakers honoraria from Bristol-Myers Squibb, Eli Lilly, Daiichi Sankyo Company and sanofi-aventis. A.I. has disclosed that he has received consulting fees from Abbott, Medtronic, Boston Scientific and Lilly. A.B. has disclosed that he recruits to and manages clinical trials and registries with commercial sponsorship from Lilly, Roche, GSK and Health-Smart and has received honoraria for educational activities and grants from Takeda, AstraZeneca, sanofi-aventis and Lilly.

Acknowledgements

The authors thank Sabina Murphy and Nicole Johnston for assistance in preparing the manuscript, and Nathan Carter for statistical support. Ms. Johnston and Mr Carter are employees of i3 Statprobe.

Data from APTOR have been presented as abstracts at Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference, April 30 – May 2, 2008, Baltimore, MD, USA; International Society for Pharmacoeconomics and Outcomes Research, May 3–7, 2008, Toronto, Canada; and European Society of Cardiology Congress, August 30 – September 3, 2008, Munich, Germany.