Faculty Collaboration Database

Trends in use of anti-thrombotic agents and outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) managed with an invasive strategy. Indian Heart J 2016;68(4):464-72

Date

08/21/2016

Pubmed ID

27543467

Pubmed Central ID

PMC4990733

DOI

10.1016/j.ihj.2015.09.036

Scopus ID

2-s2.0-84956486037 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

OBJECTIVE: To analyze trends in utilization of anti-thrombotic agents (ATA) and in-hospital clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) patients managed with an invasive strategy from 2007 to 2010.

METHODS & RESULTS: Using ACTION Registry(®)-GWTG™ data, we analyzed trends in use of ATA and in-hospital clinical outcomes among 64,199 NSTEMI patients managed invasively between 2007 and 2010. ATA included unfractionated heparin (UFH), low molecular weight heparin (LMWH), glycoprotein IIb/IIIa inhibitors (GPI) and bivalirudin. Although the proportion of NSTEMI patients treated with PCI within 48h of hospital arrival was similar in 2007 and 2010, percentage use of bivalirudin (13.4-27.3%; p<0.01) and UFH increased (60.0-67.5%, p<0.01), and that of GPI (62.3-41.0%; p<0.01) and LMWH (41.5-36.8%; p<0.01) declined. Excess dosing of UFH (75.9-59.3%, p<0.01), LMWH (9.6-5.2%; p<0.01) and GPI (8.9-5.9%, p<0.01) was also significantly lower in 2010 compared with 2007. Though in-hospital mortality rates were similar in 2007 and 2010 (2.3-1.9%, p=0.08), the rates of in-hospital major bleeding (8.7-6.6%, p<0.01) and non-CABG related RBC transfusion (6.3-4.6%, p<0.01) were significantly lower in 2010 compared with 2007.

CONCLUSION: Compared with 2007, patients with NSTEMI, who were managed invasively in 2010 received GPI and LMWH less often and bivalirudin and UFH more frequently. There were sizeable reductions in the rates of excess dosing of UFH (though still occurred in 67% of patients), GPI and LMWH. In-hospital major bleeding complications and post-procedural RBC transfusion were lower in 2010 compared with 2007.

Author List

Wayangankar SA, Roe MT, Chen AY, Gupta RS, Giugliano RP, Newby LK, de Lemos JA, Alexander KP, Sanborn TA, Saucedo JF

Author

Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Angioplasty, Balloon, Coronary
Antithrombins
Dose-Response Relationship, Drug
Electrocardiography
Female
Fibrinolytic Agents
Follow-Up Studies
Hemorrhage
Heparin, Low-Molecular-Weight
Hirudins
Hospital Mortality
Humans
Incidence
Male
Middle Aged
Non-ST Elevated Myocardial Infarction
Peptide Fragments
Recombinant Proteins
Registries
Retrospective Studies
Time Factors
United States