Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: Insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units Registry

Leonardo De Luca, Giuseppe Musumeci, Sergio Leonardi, Lucio Gonzini, Claudio Cavallini, Paolo Calabrò, Ciro Mauro, L. Cacciavillani, S. De Servi, A. P. Maggioni, G. Galasso, C. Mauro, G. Tortorella, L. Esposito, P. De Rosa, R. Bianchi, A. Boni, G. M. De Ferrari, R. Camporotondo, M. L. FinocchiaroF. Costa, G. Marenzi, E. M. Assanelli, A. Mauro, P. Costa, M. Caputo, A. Farina, V. Russo, M. Elia, S. De Servi, R. Fusco, M. De Luca, L. Fattore, A. Lombardi, M. Rossi, C. Tonelli, G. Leone, M. Gianni, A. Marzano, A. Leone, P. Rossi, M. Romano, D. Marchese, R. Fanelli, E. Gronda, D. Massa, D. Caraceni, M. Rossi, M. Gobbi, M. Cannone, on behalf of the EYESHOT Investigators, Roberto Antonicelli

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI.

Original languageEnglish
Pages (from-to)580-589
Number of pages10
JournalJournal of Cardiovascular Medicine
Volume18
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

Fingerprint

Percutaneous Coronary Intervention
Acute Coronary Syndrome
Catheterization
Registries
Platelet Glycoprotein GPIIb-IIIa Complex
Heparin
Therapeutics
Italy
Pharmaceutical Preparations
Aspirin
bivalirudin

Keywords

  • acute coronary syndromes
  • antithrombotic therapy
  • bivalirudin
  • heparins
  • percutaneous coronary intervention
  • prasugrel
  • ticagrelor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions : Insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units Registry. / De Luca, Leonardo; Musumeci, Giuseppe; Leonardi, Sergio; Gonzini, Lucio; Cavallini, Claudio; Calabrò, Paolo; Mauro, Ciro; Cacciavillani, L.; De Servi, S.; Maggioni, A. P.; Galasso, G.; Mauro, C.; Tortorella, G.; Esposito, L.; De Rosa, P.; Bianchi, R.; Boni, A.; De Ferrari, G. M.; Camporotondo, R.; Finocchiaro, M. L.; Costa, F.; Marenzi, G.; Assanelli, E. M.; Mauro, A.; Costa, P.; Caputo, M.; Farina, A.; Russo, V.; Elia, M.; De Servi, S.; Fusco, R.; De Luca, M.; Fattore, L.; Lombardi, A.; Rossi, M.; Tonelli, C.; Leone, G.; Gianni, M.; Marzano, A.; Leone, A.; Rossi, P.; Romano, M.; Marchese, D.; Fanelli, R.; Gronda, E.; Massa, D.; Caraceni, D.; Rossi, M.; Gobbi, M.; Cannone, M.; on behalf of the EYESHOT Investigators ; Antonicelli, Roberto.

In: Journal of Cardiovascular Medicine, Vol. 18, No. 8, 01.08.2017, p. 580-589.

Research output: Contribution to journalArticle

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abstract = "Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7{\%}) and non-ST-elevation ACS (77.5{\%}) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0{\%} of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7{\%} of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI.",
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T1 - Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions

T2 - Insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units Registry

AU - De Luca, Leonardo

AU - Musumeci, Giuseppe

AU - Leonardi, Sergio

AU - Gonzini, Lucio

AU - Cavallini, Claudio

AU - Calabrò, Paolo

AU - Mauro, Ciro

AU - Cacciavillani, L.

AU - De Servi, S.

AU - Maggioni, A. P.

AU - Galasso, G.

AU - Mauro, C.

AU - Tortorella, G.

AU - Esposito, L.

AU - De Rosa, P.

AU - Bianchi, R.

AU - Boni, A.

AU - De Ferrari, G. M.

AU - Camporotondo, R.

AU - Finocchiaro, M. L.

AU - Costa, F.

AU - Marenzi, G.

AU - Assanelli, E. M.

AU - Mauro, A.

AU - Costa, P.

AU - Caputo, M.

AU - Farina, A.

AU - Russo, V.

AU - Elia, M.

AU - De Servi, S.

AU - Fusco, R.

AU - De Luca, M.

AU - Fattore, L.

AU - Lombardi, A.

AU - Rossi, M.

AU - Tonelli, C.

AU - Leone, G.

AU - Gianni, M.

AU - Marzano, A.

AU - Leone, A.

AU - Rossi, P.

AU - Romano, M.

AU - Marchese, D.

AU - Fanelli, R.

AU - Gronda, E.

AU - Massa, D.

AU - Caraceni, D.

AU - Rossi, M.

AU - Gobbi, M.

AU - Cannone, M.

AU - on behalf of the EYESHOT Investigators

AU - Antonicelli, Roberto

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI.

AB - Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI.

KW - acute coronary syndromes

KW - antithrombotic therapy

KW - bivalirudin

KW - heparins

KW - percutaneous coronary intervention

KW - prasugrel

KW - ticagrelor

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