Abstract 138: Contemporary Patterns of Use of Antiplatelet Agents in Patients With Acute Myocardial Infarction: Insight From the National Cardiovascular Data Registry (NCDR)

Background: Compared with clopidogrel, ticagrelor and prasugrel are more potent and faster-acting antiplatelet agents that have been associated with a greater reduction in thrombotic cardiovascular events in patients with acute myocardial infarction (AMI). We examined contemporary patterns of P2Y12 inhibitor selection both early (within 24 h of admission) and at discharge among AMI patients captured by a large national registry. Methods: Patients in the ACTION Registry® -GWTG™ who presented with AMI from October 2013 through December 2014 were included in the study (167,455 patients from 622 sites). Among these patients, we evaluated the temporal trends in early use (within 24 h of admission) and discharge prescription of antiplatelet agents and used logistic regression to identify factors associated with P2Y12 inhibitor selection at discharge. Results: Early ticagrelor use increased significantly over time from 11.8% to 16.4% (STEMI 19.6% to 27.6%; NSTEMI 6.8% to 9.5%; p<0.0001 for all). Similarly, ticagrelor prescription at discharge increased significantly from 12% to 16.7% (STEMI 17.5% to 24.6%; NSTEMI 8.7 to 11.9%; p<0.0001 for all). During the same time period, we observed a significant decrease in the early use of prasugrel and clopidogrel (13.3% to 11.9% and 43.4% to 39.5%, respectively, p<0.0001 for all) and their prescription at discharge (15.7% to 13.9% and 54.2% to 51.1%, respectively, p<0.0001 for all) (Figure 1). Independent factors associated with ticagrelor prescription at discharge over clopidogrel included younger age, white race, HMO/private insurance, home ticagrelor use, invasive management and in-hospital re-infarction and CVA (p<0.0001 for all), whereas prior CVA, atrial fibrillation and CABG favored clopidogrel prescription at discharge. Independent factors associated with ticagrelor prescription at discharge over prasugrel included older age, female gender, prior stroke, home ticagrelor use and in-hospital CVA (p<0.001 for all), whereas prior diabetes (p<0.001) and home prasugrel use (p<0.0001) were associated with prasugrel prescription at discharge. Conclusions: Our contemporary dataset shows a modest but significant increase in use of ticagrelor early and at discharge, with simultaneous decline in the use of clopidogrel and prasugrel in patients presenting with AMI. ![][1] [1]: /embed/graphic-1.gif