Baseline characteristics, adenosine diphosphate receptor inhibitor treatment patterns, and in-hospital outcomes of myocardial infarction patients undergoing percutaneous coronary intervention in the prospective Canadian Observational AntiPlatelet sTudy (COAPT).
BACKGROUND
Contemporary use of dual antiplatelet therapy and consistency with guideline recommendations in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) have not been well characterized.


METHODS
The COAPT was a prospective, observational, multicenter, longitudinal study of patients with myocardial infarction (MI) undergoing PCI. Baseline characteristics, treatment patterns, processes of care, factors associated with switching to and from novel adenosine diphosphate receptor inhibitors (ADPris), and in-hospital outcomes are described.


RESULTS
Among 2,179 MI patients undergoing PCI during their index hospitalization, 1,328 (60.9%) had ST elevation. Initial ADPri use included clopidogrel in 1,812 (83.2%), prasugrel in 125 (5.7%), and ticagrelor in 242 (11.1%). At discharge, 1,597 patients (73.4%) were prescribed clopidogrel, 220 (10.1%) prasugrel, and 358 (16.5%) ticagrelor. Switching between ADPri therapies during the index hospitalization occurred in 15.3%, 22.4%, and 25.2% of patients initially started on clopidogrel, prasugrel, and ticagrelor, respectively. Most switches over the 15-month study period occurred during the index admission (16.8% of patients vs 4.4% switches postdischarge). Major adverse cardiovascular events occurred in 7.5% of patients during the index hospitalization. In-hospital bleeding events occurred in 6.0% of patients and most were mild.


CONCLUSIONS
Despite randomized trial evidence and guideline recommendations, only a minority of Canadian MI patients undergoing PCI initially received or were discharged on one of the newer ADPri agents. These findings suggest an opportunity to improve upon the appropriate selection of the ADPris at index hospitalization and discharge in Canadian MI patients undergoing PCI.
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada.
Jean-Pierre
JP
Déry
Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada.
Shamir R
SR
Mehta
Eli Lilly Canada Inc., Toronto, Ontario, Canada.
Harold N
HN
Fisher
Eli Lilly and Company, Indianapolis, IN.
Xiang
X
Zhang
Eli Lilly and Company, Indianapolis, IN.
Yajun Emily
YE
Zhu
Mazankowski Alberta Heart Institute, University of Alberta Hospital, Canadian VIGOUR Centre, Edmonton, Alberta, Canada.
Robert C
RC
Welsh
London Health Sciences Centre, Western University, London, Ontario, Canada.
Shahar
S
Lavi
CSSS Chicoutimi, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre hospitalier universitaire de Québec (CHUQ), Université Laval, Quebec City, Quebec, Canada.
Tomas
T
Cieza
Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
Mark A
MA
Henderson
New Brunswick Heart Centre, CardioVascular Research NB, Saint John, New Brunswick, Canada.
Sohrab
S
Lutchmedial
Royal Jubilee Hospital and Victoria Heart Institute, Victoria, British Columbia, Canada.
Anthony J Della
AJ
Siega
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Asim N
AN
Cheema
Health Sciences North, Sudbury, Ontario, Canada.
Brian Y L
BY
Wong
CHUM-Hotel-Dieu, University of Montreal, Montreal, Quebec, Canada.
Andre
A
Kokis
Prairie Vascular Research Network, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada.
Payam
P
Dehghani
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada. Electronic address: goodmans@chrc.net.
Shaun G
SG
Goodman
D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D000077144:Clopidogrel; D057915:Drug Substitution; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D000072658:Non-ST Elevated Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine