title: Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes: Insights from EPICOR, an international study of current practice patterns.
abstract: OBJECTIVE
  To describe international patterns and opportunities for improvement of pre- and in-hospital care of patients hospitalized for acute coronary syndromes (ACS), with special focus on anti-thrombotic therapy.
  
  
  RESULTS
  EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients), an international, cohort study, which enrolled 10,568 consecutive ACS survivors from 555 hospitals in 20 countries across Europe and Latin America (September 2010 to March 2011), prospectively registered detailed information on pre- and in-hospital management. Globally, 4738 (44.8%) were attended before hospitalization, 4241 (40.1%) had an ECG, 2119 (20%) received anti-platelet therapy and 101 STEMI patients (2%) fibrinolysis. In-hospital, 7944 patients (75.2%) received dual anti-platelet therapy, most often with clopidogrel (69.7%), and less with prasugrel (5.4%); 1705 (16.1%) had triple anti-platelet therapy, and 849 (8%) single anti-platelet therapy. STEMI patients more often received pre-hospital anti-thrombotics, and prasugrel, GP IIb/IIIa inhibitors and UFH in-hospital (all p < 0.001). More NSTE-ACS patients received clopidogrel, single anti-platelet therapy, and fondaparinux (all p < 0.001). As many as 33% of ACS patients were medically managed. A significant decreasing gradient was found between Northern, Southern and Eastern Europe and Latin America in use of more potent patterns of anti-platelet therapy, reperfusion therapy and invasive strategy.
  
  
  CONCLUSIONS
  This large international study shows room for improvement in use of anti-thrombotic drugs and other strategies for optimal management of ACS, including pre-hospital ECG and anti-thrombotic therapy. Regional practice differences not based on evidence or conditioned by economic constraints should be reduced.
authors.affiliation: Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón & Universidad Complutense de Madrid, Spain hecbueno@jet.es.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Sinnaeve
authors.affiliation: I-CHER Interuniversity Centre for Health Economics Research UGent, VUB, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Hôpital Européen Georges Pompidou, & René Descartes University, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: AstraZeneca France, Rueil Malmaison, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Licour
authors.affiliation: AstraZeneca Global Medical Affairs, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina
authors.affiliation: London School of Hygiene and Tropical Medicine, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: AstraZeneca Global Medical Affairs, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-Covisa
authors.affiliation: University of Sheffield, UK.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.affiliation: Leiden University Medical Center, The Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D058996:Quality Improvement
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: Acute coronary syndromes; anti-coagulants; anti-platelet drugs; real-world