Comorbidity and low use of new antiplatelets in acute coronary syndrome
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ORIGINAL ARTICLE
Comorbidity and low use of new antiplatelets in acute coronary syndrome Jaime Aboal2 · Isaac Llaó1 · Cosme García García3 · Jordi Sans‑Roselló4 · Antonia Sambola5 · Rut Andrea6 · Carlos Tomás7 · Gil Bonet8 · Albert Ariza‑Solé1 · David Viñas2 · Teresa Oliveras Vilà3 · Santiago Montero4 · Javier Cantalapiedra5 · Margarida Pujol‑López6 · Isabel Hernández7 · María Pérez‑Rodriguez8 · Pablo Loma‑Osorio2 · José Carlos Sánchez‑Salado1 Received: 15 July 2019 / Accepted: 3 September 2019 © Springer Nature Switzerland AG 2019
Abstract Introduction Despite the use of the new generation P2Y12 inhibitors (Ticagrelor and Prasugrel) with aspirin is the recommended therapy in acute NSTE-ACS patients, their current use in clinical practice remains quite low and might be related, among several variables, with increased comorbidity burden. We aimed to assess the prevalence of these treatments and whether their use could be associated with comorbidity. Method A multicentric prospective registry was conducted at 8 Cardiac Intensive Care Units (October 2017–April 2018) in patients admitted with non ST elevation myocardial infarction. Antithrombotic treatment was recorded and the comorbidity risk was assessed using the Charlson Comorbidity Index. We created a multivariate model to identify the independent predictors of the use of new inhibitors of P2Y12. Results A total of 629 patients were included, median age 67 years, 23.2% women, 359 patients (57.1%) treated with clopidogrel and 40.6% with new P2Y12 inhibitors: ticagrelor (228 patients, 36.2%) and prasugrel (30 patients, 4.8%). Among the patients with very high comorbidity (Charlson Score > 6) clopidogrel was the drug of choice (82.6%), meanwhile in patients with low comorbility (Charlson Score 0–1) was the ticagrelor or prasugrel (63.6%). Independent predictors of the use of ticagrelor or prasugrel were a low Charlson Comorbidity Index, a low CRUSADE score and the absence of prior bleeding. Conclusion Antiplatelet treatment with Ticagrelor or Pasugrel was low in patients admitted with NSTE-ACS. Comorbidity calculated with Charlson Comorbidity Index was a powerful predictor of the use of new generation P2Y12 inhibitors in this population. Keywords Comorbidity · Non-ST elevation acute coronary syndromes · Clopidogrel · Ticagrelor · CHARLSON Comorbidity Index Abbreviations NSTE-ACS Non-ST-segment elevation acute coronary syndrome NAAs P2Y12-inhibitor antiplatelet agents (ticagrelor and prasugrel) CICUs Cardiac intensive care units
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The combination of P2Y12 inhibitors with aspirin in the treatment of acute coronary syndrome has proven to be effective in terms of reducing ischemic events [1, 2]. The first drug to be used with good results was clopidogrel, an 4
Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Barcelona, Spain
Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Hospital Universitari de la Vall d’H
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