title: Prior antiplatelet use and cardiovascular outcomes in patients presenting with acute coronary syndromes.
abstract: BACKGROUND
  Although antiplatelet therapy effectively reduces ischemic events, the cardiovascular (CV) outcome in some cases is still unpredictable.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the impact of prior single or dual antiplatelet (PAP) use in patients presenting with acute coronary syndromes (ACS).
  
  
  METHODS
  Data were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were grouped according to whether they were PAP users or not (NAP). Patients' characteristics and outcomes were analyzed and compared. Mortality was assessed at 1 and 12 months.
  
  
  RESULTS
  Among 7827 consecutive ACS patients, 41% were PAP users (70% aspirin, 1% clopidogrel, and 29% dual antiplatelet agents). In comparison with NAP use, PAP use was associated with a higher rate of co-morbidities, atypical presentation, severe left ventricular dysfunction, three-vessel disease, and a high GRACE risk score. After adjustment for relevant covariates, PAP use was an independent predictor for recurrent ischemia in unstable angina (odds ratio [OR] 1.7; 95% CI 1.17, 2.57) and non-ST-elevation myocardial infarction (NSTEMI) [OR 1.9; 95% CI 1.38, 2.65] and for heart failure in NSTEMI (OR 1.5; 95% CI 1.11, 2.15) and STEMI (OR 1.4; 95% CI 1.08, 1.93). Although PAP use was associated with high mortality in STEMI and NSTEMI, it was not an independent predictor for mortality. Among PAP patients, percutaneous coronary intervention independently reduced the risk of hospital (adjusted OR 0.25; 95% CI 0.20, 0.32), 1-month (OR 0.31; 95% CI 0.26, 0.37), and 12-month mortality (OR 0.28; 95% CI 0.24, 0.33).
  
  
  CONCLUSIONS
  PAP use identified a high-risk population across the ACS spectrum. Early coronary revascularization may improve CV outcomes in these patients.
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Motarreb
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hersi
authors.forename: Hussam
authors.initials: H
authors.lastname: Al Faleh
authors.forename: Nidal
authors.initials: N
authors.lastname: Asaad
authors.forename: Shukri
authors.initials: S
authors.lastname: Al Saif
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.forename: Kadhim
authors.initials: K
authors.lastname: Sulaiman
authors.forename: Haitham
authors.initials: H
authors.lastname: Amin
authors.forename: Jawad
authors.initials: J
authors.lastname: Al-Lawati
authors.forename: Alawi A
authors.initials: AA
authors.lastname: Alsheikh-Ali
authors.forename: Awad
authors.initials: A
authors.lastname: AlQahtani
authors.forename: Norah Q
authors.initials: NQ
authors.lastname: Al-Sagheer
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin