title: Trends in use of anti-thrombotic agents and outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) managed with an invasive strategy.
abstract: OBJECTIVE
  To analyze trends in utilization of anti-thrombotic agents (ATA) and in-hospital clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) patients managed with an invasive strategy from 2007 to 2010.
  
  
  RESULTS
  Using ACTION Registry(®)-GWTG™ data, we analyzed trends in use of ATA and in-hospital clinical outcomes among 64,199 NSTEMI patients managed invasively between 2007 and 2010. ATA included unfractionated heparin (UFH), low molecular weight heparin (LMWH), glycoprotein IIb/IIIa inhibitors (GPI) and bivalirudin. Although the proportion of NSTEMI patients treated with PCI within 48h of hospital arrival was similar in 2007 and 2010, percentage use of bivalirudin (13.4-27.3%; p<0.01) and UFH increased (60.0-67.5%, p<0.01), and that of GPI (62.3-41.0%; p<0.01) and LMWH (41.5-36.8%; p<0.01) declined. Excess dosing of UFH (75.9-59.3%, p<0.01), LMWH (9.6-5.2%; p<0.01) and GPI (8.9-5.9%, p<0.01) was also significantly lower in 2010 compared with 2007. Though in-hospital mortality rates were similar in 2007 and 2010 (2.3-1.9%, p=0.08), the rates of in-hospital major bleeding (8.7-6.6%, p<0.01) and non-CABG related RBC transfusion (6.3-4.6%, p<0.01) were significantly lower in 2010 compared with 2007.
  
  
  CONCLUSIONS
  Compared with 2007, patients with NSTEMI, who were managed invasively in 2010 received GPI and LMWH less often and bivalirudin and UFH more frequently. There were sizeable reductions in the rates of excess dosing of UFH (though still occurred in 67% of patients), GPI and LMWH. In-hospital major bleeding complications and post-procedural RBC transfusion were lower in 2010 compared with 2007.
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States. Electronic address: wayangs@ccf.org.
authors.forename: S A
authors.initials: SA
authors.lastname: Wayangankar
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: M T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: A Y
authors.initials: AY
authors.lastname: Chen
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: R S
authors.initials: RS
authors.lastname: Gupta
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: R P
authors.initials: RP
authors.lastname: Giugliano
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: L K
authors.initials: LK
authors.lastname: Newby
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: J A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: K P
authors.initials: KP
authors.lastname: Alexander
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: T A
authors.initials: TA
authors.lastname: Sanborn
authors.affiliation: Cleveland Clinic, Cleveland, OH, United States; Duke Clinical Research Institute, Durham, NC, United States; Deaconess Hospital, Oklahoma City, OK, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States; Northshore University Health System, Evanston, IL, United States.
authors.forename: J F
authors.initials: JF
authors.lastname: Saucedo
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000991:Antithrombins / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006629:Hirudins / Q000008:administration & dosage*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D010446:Peptide Fragments / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Anti-thrombotic agents; Invasive strategy; Non-ST-segment elevation myocardial infarction