title: P2Y12 receptor inhibitors in patients with non-ST-elevation acute coronary syndrome in the real world: use, patient selection, and outcomes from contemporary European registries.
abstract: Non-ST-elevation acute coronary syndrome (NSTE-ACS) is present in about 60-70% of patients admitted with acute coronary syndromes in clinical practice. This study provides a 'real-life' overview of NSTE-ACS patient characteristics, dual antiplatelet therapy clinical practice, and outcomes at both the time of discharge from hospital and up to 1-year post-discharge.
  
  
  
  A total of 10 registries (documenting 84 054 NSTE-ACS patients) provided data in a systematic manner on patient characteristics and outcomes for NSTE-ACS in general, and 6 of these (with 52 173 NSTE-ACS patients) also provided more specific data according to P2Y12 receptor inhibitor used. Unadjusted analyses were performed at the study level, and no formal meta-analysis was performed due to large heterogeneity between studies in the settings, patient characteristics, and outcome definitions. All-cause death rates across registries ranged from 0.76 to 4.79% in-hospital, from 1.61 to 6.65% at 30 days, from 3.66 to 7.16% at 180 days, and from 3.14 to 9.73% at 1 year. Major bleeding events were reported in up to 2.77% of patients while in hospital (in seven registries), up to 1.08% at 30 days (data from one registry only), and 2.06% at 1 year (one registry).
  
  
  
  There were substantial differences in the use of and patient selection for clopidogrel, prasugrel, and ticagrelor, which were associated with differences in short- and long-term ischaemic and bleeding events. In future registries, data collection should be performed in a more standardized way with respect to endpoints, definitions, and time points.
authors.affiliation: Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Bremser Str. 79, D-67063 Ludwigshafen, Germany uwe.zeymer@t-online.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.affiliation: Department of Cardiology, Hospital Européen Georges Pompidou and Université Paris Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Cardiology Unit, Humanitas Research Hospital, Rozzano, Milano, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Lettino
authors.affiliation: Cardiology Service, Hospital Universitari de Tarragona Joan XXIII, IISPV, Tarragona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bardaji
authors.affiliation: Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Barrabes
authors.affiliation: Heart Disease Institute, Bellvitge University Hospital IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Department of Cardiology, University Hospital Antwerp, Edegem, Belgium.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Claeys
authors.affiliation: Department of Cardiovascular Sciences, Laboratory of Interventional Cardiology European Hospital, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Jakob
authors.initials: J
authors.lastname: Dörler
authors.affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.affiliation: AMIS Plus Data Center, University of Zurich, Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Pôle de l'urgence, Service de SAMU du Nord, Centre Hospitalier régional Universitaire de Lille, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, Lund, Sweden.
authors.forename: Sasha M
authors.initials: SM
authors.lastname: Koul
authors.affiliation: Cardiac Intensive Care Unit, Interventional Cardiology Hopital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.affiliation: Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Matter
authors.affiliation: Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.affiliation: Cardiology Department, Hospital La Paz. IdiPaz, Madrid, Spain.
authors.forename: Jose Lopez
authors.initials: JL
authors.lastname: Sendón
authors.affiliation: Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Tousek
authors.affiliation: Second Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Weidinger
authors.affiliation: Swansea University, Medical School, Swansea, Wales, UK.
authors.forename: Clive F M
authors.initials: CF
authors.lastname: Weston
authors.affiliation: Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle upon Tyne, UK.
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, Lund, Sweden.
authors.forename: Pontus
authors.initials: P
authors.lastname: Andell
authors.affiliation: Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12; D012042:Registries; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12
keywords: Acute coronary syndromes; Antiplatelets; Clopidogrel; Non-ST-segment elevation; Observational; P2Y12 receptor inhibitors; Prasugrel; Ticagrelor