title: Implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a report from the GReek AntiPlatelet rEgistry (GRAPE).
abstract: BACKGROUND
  Few data exist about the implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  GReek AntiPlatelet rEgistry (GRAPE), initiated on January 2012, is a prospective, observational, multicenter cohort study focusing on contemporary use of P2Y12 inhibitors. In 1434 patients we evaluated appropriateness of P2Y12 selection initially and at discharge by applying an eligibility-assessing algorithm based on P2Y12 inhibitors' contraindications/specific warnings and precautions.
  
  
  RESULTS
  Appropriate, less preferable and inappropriate P2Y12 inhibitor selections were made initially in 45.8%, 47.2% and 6.6% and at discharge in 64.1%, 29.2% and 6.6% of patients, respectively. The selection of clopidogrel was most commonly less preferable, both initially (69.7%) and at discharge (75.6%). Appropriate selection of newer agents was high initially (79.2%-82.8%), with further increase as selection at discharge (89.4%-89.8%). Inappropriate selection of the newer agents was 17.2%-20.8% initially, decreasing to 10.2%-10.6% at discharge. Conditions and co-medications related to increased bleeding risk, presentation with ST elevation myocardial infarction and the absence of reperfusion within the first 24h were the most powerful predictors of appropriate P2Y12 selection initially, whereas age ≥75 years, conditions and co-medications related to increased bleeding risk and regional trends mostly affected appropriate P2Y12 selection at discharge.
  
  
  CONCLUSIONS
  In GRAPE, adherence with the recently released guidelines on oral antiplatelet therapy was satisfactory. Clopidogrel was most commonly used as a less preferable selection, while prasugrel or ticagrelor selection was mostly appropriate. Certain factors may predict initial and at discharge guideline implementation. Clinical Trial Registration-clinicaltrials.gov Identifier: NCT01774955 http://clinicaltrials.gov/.
authors: Patras University Hospital, Department of Cardiology, Patras, Greece. Electronic address: dalex@med.upatras.gr.
authors: Dimitrios
authors: D
authors: Alexopoulos
authors: John A
authors: JA
authors: Goudevenos
authors: Ioanna
authors: I
authors: Xanthopoulou
authors: Spyridon
authors: S
authors: Deftereos
authors: George
authors: G
authors: Sitafidis
authors: Ioannis
authors: I
authors: Kanakakis
authors: Michalis
authors: M
authors: Hamilos
authors: Haralambos
authors: H
authors: Parissis
authors: Ioannis V
authors: IV
authors: Ntalas
authors: Christos
authors: C
authors: Angelidis
authors: Stylianos
authors: S
authors: Petousis
authors: Manolis
authors: M
authors: Vavuranakis
authors: George
authors: G
authors: Hahalis
authors: Christodoulos
authors: C
authors: Stefanadis
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D000284:Administration, Oral; D000368:Aged; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011217:Practolol; D000068799:Prasugrel Hydrochloride; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D058925:Receptors, Purinergic P2Y12; D012042:Registries; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: C548576:P2RY12 protein, human; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D011217:Practolol
keywords: Acute coronary syndrome; Antiplatelet therapy; Guideline adherence; ST-segment elevation myocardial infarction