Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: the Canadian global registry of acute coronary events (GRACE) experience
Banihashemi, Behnam ; Goodman, Shaun G. ; Yan, Raymond T. ; Welsh, Robert C. ; Meta, Shamir R. ; Montalescot, Gilles ; Kornder, Jan ; Wong, Graham C. ; Gyenes, Gabor ; Steg, Phillippe Gabriel ... show 2 more
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Abstract
BACKGROUND:
There are limited contemporary data on the early use of clopidogrel or glycoprotein (Gp) IIb/IIIa inhibitors, alone versus combination therapies, in non-ST-elevation acute coronary syndrome (NSTE-ACS).
METHODS:
This study included 5,806 Canadian NSTE-ACS patients with elevated cardiac biomarker and/or ST deviation on presentation in the prospective GRACE between 2003-2007. We stratified the study population according to the management strategy (non-invasive vs invasive) and into low-(GRACE risk score or=141).
RESULTS:
Overall, 3,893 patients (67.1%) received early (
CONCLUSIONS:
In this contemporary NSTE-ACS population, both clopidogrel and GpIIb/IIIa inhibitors were targeted toward patients treated with an invasive strategy but paradoxically toward the lower-risk group. In particular, clopidogrel appeared to be underused among conservatively managed patients despite its proven efficacy, whereas GpIIb/IIIa inhibitors were administered to only a minority of the high-risk patients with elevated cardiac biomarkers. Our findings emphasize the ongoing need to promote the optimal use of evidence-based antiplatelet therapies among high-risk patients with NSTE-ACS.
Source
Am Heart J. 2009 Dec;158(6):917-24. Link to article on publisher's site