Switching between thienopyridines in patients with acute myocardial infarction and quality of care.
|Title||Switching between thienopyridines in patients with acute myocardial infarction and quality of care.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Schiele, F., E. Puymirat, L. Bonello, N. Meneveau, J. - P. Collet, P. Motreff, R. Ravan, F. Leclercq, P. - V. Ennezat, J. Ferrières, T. Simon, and N. Danchin|
OBJECTIVE: In acute coronary syndromes, switching between thienopyridines is frequent. The aims of the study were to assess the association between switching practices and quality of care.
METHODS: Registry study performed in 213 French public university, public non-academic and private hospitals. All consecutive patients admitted for acute myocardial infarction (MI; <48 hours) between 1/10/2010 and 30/11/2010 were eligible. Clinical and biological data were recorded up to 12 months follow-up.
RESULTS: Among 4101 patients receiving thienopyridines, a switch was performed in 868 (21.2%): 678 (16.5%) from clopidogrel to prasugrel and 190 (4.6%) from prasugrel to clopidogrel. Predictors of switch were ST segment elevation MI presentation, admission to a cardiology unit, previous percutaneous coronary intervention, younger age, body weight >60 kg, no history of stroke, cardiac arrest, anaemia or renal dysfunction. In patients with a switch, eligibility for prasugrel was >82% and appropriate use of a switch was 86% from clopidogrel to prasugrel and 20% from prasugrel to clopidogrel. Quality indicators scored higher in the group with a switch and also in centres where the switch rate was higher.
CONCLUSIONS: As applied in the French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction (FAST-MI) registry, switching from one P2Y12 inhibitor to another led to a more appropriate prescription and was associated with higher scores on indicators of quality of care.
|Alternate Journal||Open Heart|