Abstract 18893: ADP Receptor Inhibitor Therapy Use Beyond 12 Months in Community Practice: Results From the Translate-ACS Registry
Background: Prolonged use of ADP receptor inhibitors (ADPri) beyond 1 year following myocardial infarction (MI) and percutaneous coronary intervention (PCI) is supported by recent studies such as DAPT and PEGASUS. In community practice, how often and in which patients prolonged ADPri therapy is used is poorly understood.
Methods: Using data from the TRANSLATE-ACS observational study, we examined prevalence of ADPri continuation beyond 1 year post-MI in routine US practice (2010-2012) and used multivariable logistic regression to identify patient characteristics associated with ADPri use beyond 1 year.
Results: Of 8,749 patients alive and still on ADPri at 12 months post-MI, 6,627 (76%) were still on ADPri at the 15-month interview. ADPri use beyond 1 year occurred more frequently among black vs. white patients (82.7% vs. 75.1%), patients with prior PCI (85.4% vs. 73.2%) or prior CABG (87.0% vs. 74.5%), and those with multivessel disease (78.8% vs. 72.7%, p<0.001 for all). Use of drug eluting stents did not affect likelihood of prolonged ADPri use, 77% in both groups (p= 0.98). Patients discharged on prasugrel/ticagrelor were less likely to continue their ADPri beyond 1 year than those discharged on clopidogrel (71.1% vs. 77.9%, p<0.001). Unplanned coronary revascularization occurred more commonly within the first 1 year post-MI among patients who continued on ADPri beyond 1 year (14.3% vs. 4.6%, p<0.001), but the rate of BARC 2+ bleeding was lower (19.9% vs. 22.3%, p=0.02) than those who stopped ADPri at 1 year. These variables remained independent factors associated with post-1 year ADPri continuation in multivariable modeling (Figure).
Conclusion: In routine US practice, the majority of MI patients who underwent PCI were already receiving prolonged ADPri therapy beyond 1 year even before DAPT and PEGASUS trials. Post-discharge unplanned revascularization and bleeding appear to be the strongest predictors for and against prolonged ADPri use, respectively.
Author Disclosures: J.D. Hansen: None. L.A. McCoy: None. D.J. Cohen: Research Grant; Significant; Eli Lilly, Daiichi Sankyo, AstraZeneca. Honoraria; Modest; Eli Lilly, Astra Zeneca. Consultant/Advisory Board; Significant; Eli Lilly, Astra Zeneca. T.D. Henry: Honoraria; Modest; Eli Lilly, Daiichi Sankyo. G. Fonarow: Consultant/Advisory Board; Modest; Medtronic, Amgen, Johnson & Johnson, Bayer, Boston Scientific. Research Grant; Significant; NIH. Consultant/Advisory Board; Significant; Novartis. M.B. Effron: Employment; Significant; Employee of Eli Lilly & Company. Ownership Interest; Significant; Shareholder of Lilly, USA. M.E. Zettler: Employment; Significant; Eli Lilly & Company. B.A. Baker: Employment; Significant; Daiichi Sankyo, Inc. E.D. Peterson: Research Grant; Significant; American College of Cardiology, American Heart Association, Eli Lilly & Company, Janssen Pharmaceuticals, Society of Thoracic Surgeons. Consultant/Advisory Board; Modest; Merck & Co. Consultant/Advisory Board; Significant; Boehringer Ingelheim, Genentech, Janssen Pharmaceuticals, Sanofi-Aventis, Bayer. T.Y. Wang: Research Grant; Modest; Bristol Myers Squibb. Research Grant; Significant; Eli Lilly, Daiichi Sankyo, Gilead Science, GlaxoSmithKline, Astra Zeneca, Boston Scientific, Regeneron. Honoraria; Modest; Astra Zeneca, Eli Lilly, Premier.
- © 2015 by American Heart Association, Inc.