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Comorbidity and low use of new antiplatelets in acute coronary syndrome

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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.

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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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Authors and Affiliations

  1. Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Barcelona, Spain

    Isaac Llaó, Albert Ariza-Solé & José Carlos Sánchez-Salado

  2. Servicio de Cardiología, Hospital Universitari Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain

    Jaime Aboal, David Viñas & Pablo Loma-Osorio

  3. Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain

    Cosme García García & Teresa Oliveras Vilà

  4. 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

    Jordi Sans-Roselló & Santiago Montero

  5. Hospital Universitari de la Vall d’Hebron, Barcelona, Spain

    Antonia Sambola & Javier Cantalapiedra

  6. Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain

    Rut Andrea & Margarida Pujol-López

  7. Hospital Arnau de Vilanova, Lleida, Spain

    Carlos Tomás & Isabel Hernández

  8. Hospital Joan XXIII, Tarragona, Spain

    Gil Bonet & María Pérez-Rodriguez

Authors
  1. Jaime Aboal
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  2. Isaac Llaó
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  3. Cosme García García
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  14. Margarida Pujol-López
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  18. José Carlos Sánchez-Salado
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Corresponding author

Correspondence to Jaime Aboal.

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Authors declare all the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Aboal, J., Llaó, I., García García, C. et al. Comorbidity and low use of new antiplatelets in acute coronary syndrome. Aging Clin Exp Res 32, 1525–1531 (2020). https://doi.org/10.1007/s40520-019-01348-7

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  • DOI: https://doi.org/10.1007/s40520-019-01348-7

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