title: Real-World Use of Novel P2Y12 Inhibitors in Patients with Acute Myocardial Infarction: A Treatment Paradox.
abstract: OBJECTIVE
  To assess the real-world use, clinical outcomes, and adherence to novel P2Y12 inhibitors.
  
  
  METHODS
  We evaluated 1,093 consecutive acute myocardial infarction patients undergoing a percutaneous intervention. Patients were derived from a prospective, multicenter, nationwide registry and were followed for 30 days; 381 patients (35%) received clopidogrel, 468 (43%) received prasugrel, and 244 (22%) received ticagrelor. Patients treated with clopidogrel were older and more likely to suffer from chronic renal failure and stroke and/or present with non-ST-elevation myocardial infarction (NSTEMI) (p < 0.01 for all). Independent predictors of undertreatment with novel P2Y12 inhibitors included: older age (OR 0.17; 95% CI 0.1-0.27, p < 0.0001), a prior stroke (OR 0.41; 95% CI 0.2-0.68, p = 0.008), and NSTEMI (OR 0.37; 95% CI 0.26-0.54, p < 0.0001).
  
  
  RESULTS
  Novel P2Y12 inhibitors were associated with a lower incidence of cardiovascular events, major bleeding, and/or death (7.6 vs.11%, HR 0.67; 95% CI 0.43-1, p = 0.05). However, after a multivariate analysis this trend was not statistically significant. Patients discharged with ticagrelor versus thienopyridines demonstrated a higher rate of crossover to other P2Y12 inhibitors (11 vs. 5%, p = 0.03).
  
  
  CONCLUSIONS
  In a real-world cohort, there was an underutilization of novel P2Y12 inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P2Y12 inhibitors at least as much as other patients.
authors.affiliation: The Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.forename: Guy
authors.initials: G
authors.lastname: Witberg
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
authors.forename: Ronny
authors.initials: R
authors.lastname: Alcalai
authors.forename: Michael
authors.initials: M
authors.lastname: Kapeliovich
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Elad
authors.initials: E
authors.lastname: Asher
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine