Factors Associated With Initial Prasugrel Versus Clopidogrel Selection for Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From the Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study Coronary Heart Disease

We examined patients presenting with acute myocardial infarction treated with percutaneous coronary intervention at 233 US hospitals in the TRANSLATE‐ACS observational study from April 2010 to October 2012. We developed a multivariable logistic regression model to identify factors associated with prasugrel selection. Prasugrel use rates and associated 1‐year risk‐adjusted major adverse cardiovascular events and Global Utilization of Streptokinase and t‐PA for Occluded Coronary Arteries (GUSTO) moderate/severe bleeding outcomes were also examined in relation to predicted mortality and bleeding using the validated Acute Coronary Treatment and Intervention Outcomes (ACTION) risk prediction scores. Among 11 969 patients, 3123 (26%) received prasugrel at the time of percutaneous coronary intervention. The strongest factors associated with prasugrel use included cardiogenic shock (odds ratio [OR] 1.68, 95% CI 1.25–2.26), drug‐eluting stent use (OR 1.45, 95% CI 1.31–1.62), and ST‐segment elevation myocardial infarction presentation (OR 1.23, 95% CI 1.12–1.35). Older age (OR 0.57, 95% CI 0.0.53–0.61), dialysis (OR 0.56, 95% CI 0.32–0.96), prior history of stroke/transient ischemic attack (OR 0.52, 95% CI 0.38–0.73), and interhospital transfer (OR 0.50, 95% CI 0.46–0.55) were associated with lowest prasugrel selection. Prasugrel was used less often than clopidogrel in patients at higher predicted bleeding risk (21.9% versus 29...
Source: JAHA:Journal of the American Heart Association - Category: Cardiology Authors: Tags: Acute Coronary Syndromes, Coronary Artery Disease Original Research Source Type: research

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Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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