Document Detail


Temporal trends and patterns of early clopidogrel use across the spectrum of acute coronary syndromes.
MedLine Citation:
PMID:  19332190     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Randomized trials have established efficacy of clopidogrel in various types of acute coronary syndromes (ACS). The objective of this study was to examine the temporal trends and patterns of early clopidogrel use (within the first 24 hours of hospitalization) across the spectrum of patients with ACS in Canada. METHODS: Using the multinational, prospective GRACE (Global Registry of Acute Coronary Events) and GRACE(2), we identified 11,177 patients who were admitted for ACS from January 2003 to December 2007 in Canada. Demographic information, clinical features, and treatment were recorded. We examined the early use of clopidogrel over time and in relation to the type of ACS, clinical features on presentation, and the mode of reperfusion therapy. RESULTS: Of the 11,177 patients with ACS, 3,091 (27.7%) had ST-elevation myocardial infarction (STEMI), 5,194 (46.5%) had non-STEMI, and 2,892 (25.9%) had unstable angina; the rates of early clopidogrel administration were 63.0%, 66.6%, and 57.2%, respectively (P < .001). Overall, there was a significant increase in clopidogrel use over the period studied (P for trend < .001). In patients with non-ST-elevation ACS (non-STEMI and unstable angina), clopidogrel use was higher among those with positive cardiac biomarkers compared to those without (67.1% vs 59.8%, P < .001) but similar in the groups with and without ST deviation. There was an inverse relationship between GRACE risk score and rates of early clopidogrel administration. In patients with STEMI receiving fibrinolytic therapy, only 55.7% of patients <65 years old received clopidogrel compared with 47.0% and 42.6% of patients 65 to 74 and >75 years old, respectively (P for trend < .001). CONCLUSIONS: Although early use of clopidogrel therapy has increased over time across the spectrum of ACS, a significant proportion of eligible patients still do not receive this evidence-based therapy. There is a need to optimize the use of proven antiplatelet therapies to improve clinical outcome.
Authors:
Rajeev V Rao; Shaun G Goodman; Raymond T Yan; Frederick A Spencer; Keith A Fox; J Paul DeYoung; Barry Rose; François R Grondin; Richard Gallo; Joel M Gore; Andrew T Yan;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  157     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-21     Revised Date:  2009-05-19    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  642-50.e1     Citation Subset:  AIM; IM    
Affiliation:
Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, and The Canadian Heart Research Centre, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis,  drug therapy*
Aged
Drug Utilization
Electrocardiography
Female
Follow-Up Studies
Heart Catheterization
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors / administration & dosage,  therapeutic use*
Prospective Studies
Registries
Ticlopidine / administration & dosage,  analogs & derivatives*,  therapeutic use
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel
Investigator
Investigator/Affiliation:
Shaun Goodman / ; Brigita Zile / ; James Cha / ; Jill Bilich / ; Maria De Villa / ; Carolyn Vardy / ; Roland Leader / ; Carrie Harrison / ; Rajen Chetty / ; Debbie Rickeard / ; Fred Spencer / ; Pam Stevens / ; Imelda Esporlas-Jewer / ; Allan Hess / ; Robert Bauer / ; Teosar Bhesania / ; Eric Gangbar / ; Hans Strauss / ; Richard Gallo / ; Nathalie Gendron / ; Colette Anctil / ; Jean-Pierre Picard / ; Real Brossoit / ; Celine Peck / ; Jean Diodati / ; Celine Groulx / ; Jean-Pierre Dery / ; Marie-Mai Larivere / ; Suzanne Keilani / ; Francois Grondin / ; Noella Bilodeau / ; Francine Dumont / ; Gaeten Houde / ; Stephanie Rousseau / ; Richard Haichin / ; Violeta Toyota / ; Thao Huynh / ; Analia Robinowicz / ; Y K Chan / ; Dianna Zaniol / ; Donna Lee Mallette / ; Ashok Mukherjee / ; Bev Bozek / ; Sven Pallie / ; Sheila Krekorian / ; J Paul DeYoung / ; Marian Watt / ; Denis Chauret / ; Micheline Marquis / ; Ava Eargibay / ; Christopher Lai / ; Grace Fox / ; James Cherry / ; Barbara Ross / ; Petr Polasek / ; Violette Stedham / ; Michelle Mantle / ; Jan Kornder / ; Helen Elliott / ; Donald Hilton / ; Marion Johnson / ; Bev Lowe / ; Kevin Lai / ; Gail Hannah / ; Francis Ervin / ; Zhanna Yarkayeva / ; Carolyn Baer / ; Rhonda Steeves / ; Christian Paillard / ; Cecile Paillard / ; Wadea Tarhuni / ; Diane Ireland / ; Denise Bunnell / ; Kon Son / ; Sherry Deyoung / ; Graham Wong / ; Joanne Gamache / ; Gabor Gyenes / ; Linda Harris / ; Joann Flathers / ; Gerry Simkus / ; Carol Marchand / ; Peter Giannoccaro / ; Peggy Beresford / ; Thomas Ashton /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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