title: Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries.
abstract: Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in patients with STEMI based on the data from contemporary European ACS registries.
  
  
  
  Twelve registries provided data in a systematic manner on outcomes in STEMI patients overall, and seven of these also provided data for P2Y12 receptor inhibitor-based dual antiplatelet therapy. The registries were heterogeneous in terms of site, patient, and treatment selection, as well as in definition of endpoints (e.g. bleeding events). All-cause death rates based on the data from 84 299 patients (9612 patients on prasugrel, 11 492 on ticagrelor, and 27 824 on clopidogrel) ranged between 0.49 and 6.68% in-hospital, between 3.07 and 7.95% at 30 days (reported in 6 registries), between 8.15 and 9.13% at 180 days, and between 2.41 and 9.58% at 1 year (5 registries). Major bleeding rates were 0.09-3.55% in-hospital (8 registries), 0.09-1.65% at 30 days, and 1.96% at 1 year (only 1 registry). Fatal/life-threatening bleeding was rare occurring between 0.08 and 0.13% in-hospital (4 registries) and 1.96% at 1 year (1 registry).
  
  
  
  Real-world evidence from European contemporary registries shows that death, ischaemic events, and bleeding rates are lower than those reported in Phase III studies of P2Y12 inhibitors. Regarding individual P2Y12 inhibitors, patients on prasugrel, and, to a lesser degree, ticagrelor, had fewer ischaemic and bleeding events at all time points than clopidogrel-treated patients. These findings are partly related to the fact that the newer agents are used in younger and less ill patients.
authors.affiliation: Department of Cardiology, Hospital Europeen Georges Pompidou, AP-HP, Paris, France Université Paris Descartes, Paris, France nicolasdanchin@yahoo.fr.
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: Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany.
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: 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, 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, Skåne University Hospital, 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: Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Department of Cardiology, 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
authors.initials: J
authors.lastname: Lopez Sendón
authors.affiliation: Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Tousek
authors.affiliation: 2nd 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, College of Medicine, 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, Skåne University Hospital, Lund, Sweden.
authors.forename: Pontus
authors.initials: P
authors.lastname: Andell
authors.affiliation: Department of Cardiology, 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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023381:Endpoint Determination; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000187:drug effects*; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12
keywords: Acute coronary syndromes; Antiplatelet agents; Clopidogrel; Effectiveness; Methodology; Observational; P2Y12 receptor inhibitors; Prasugrel; Real-world evidence; ST-segment elevation myocardial infarction; Safety; Ticagrelor