Abstract 12791: Predictors and Outcomes of Patients With Acute Coronary Syndrome Who Receive Optimal Therapy: Results From the Antiplatelet Treatment Observational Registries (APTOR I and II)
OBJECTIVES: We evaluated predictors and outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) and received optimal secondary prevention therapy (compliant with ≥5 of the following at hospital discharge and at one-year post-PCI: aspirin, clopidogrel, statins, beta-blockers, ARB/ACE-inhibitors, and exercise or diet).
METHODS: Data were from APTOR I and II, prospective, observational registries of 14 European countries from 2007-2009. Kaplan-Meier (KM) estimates at one-year post-PCI were calculated for CV event, bleeding, and mortality. Multivariate logistic regression models identified factors associated with receiving optimal therapy.
RESULTS: 1820/4184 (44%) patients (923/2233 [41%] of patients with unstable angina [UA]/non-ST-elevated myocardial infarction [NSTEMI) and 897/1951 [46%] with STEMI) received optimal therapy, ranging from 25% in the Czech Republic to 71% in Austria and Hungary. The optimal secondary prevention therapy cohort had more comorbidities (diabetes mellitus and hypertension) and were more likely to receive ≥1 drug-eluting stents (DES), glycoprotein IIb/IIIa (gpIIb/IIIa) inhibitors and higher clopidogrel loading (LD) and maintenance doses. The KM estimates (95% CI) for optimal and non-optimal cohorts, respectively, were 16.4% (14.4%, 18.4%) and 15.1% (13.3%, 16.9%) for CV event, 2.9% (2.1%, 3.6%) and 2.8% (2.1%, 3.4%) for bleeding, and 0.9% (0.5%, 1.4%) and 1.3% (0.9%, 1.8%) for mortality. STEMI, ≥1 DES, gpIIb/IIIa inhibitor use, clopidogrel LD >300 mg, and prior use of beta blockers and ACE inhibitors were associated with receiving optimal therapy. Patients who were older, who had a prior PCI, or previous clopidogrel use were less likely to receive optimal therapy.
CONCLUSIONS: In our contemporary, European ACS-PCI registry, optimal therapy was maintained in <50% of patients with geographical differences. Despite higher comorbidities for patients in the optimal cohort, both cohorts had similar post-discharge to 1-year outcomes, suggesting a potential benefit that could be provided to all ACS revascularisation patients.
- © 2011 by American Heart Association, Inc.