Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study

Shaun G Goodman, Jose C Nicolau, Gema Requena, Andrew Maguire, Stefan Blankenberg, Ji Yan Chen, Christopher B Granger, Richard Grieve, Stuart J Pocock, Tabassome Simon, Satoshi Yasuda, Ana Maria Vega, David Brieger, TIGRIS Study Investigators, Giancarlo Silvio Marenzi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE: To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions.

METHODS: Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904).

RESULTS: 9225 patients were enrolled (median 1.8years) post-MI: 52% with prior ST-elevation MI, median age 67years, 24% women, 67% Caucasian, 55% had ≥2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥140/90mmHg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6years); continued DAPT >1year was highest (39%) in Asia-Pacific and lowest (12%) in Europe.

CONCLUSIONS: Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.

Original languageEnglish
Pages (from-to)54-60
Number of pages7
JournalInternational Journal of Cardiology
Volume236
DOIs
Publication statusPublished - Jun 1 2017

Fingerprint

Risk Management
Observational Studies
Coronary Artery Disease
Myocardial Infarction
Delivery of Health Care
clopidogrel
Guidelines
Creatinine

Keywords

  • Aged
  • Aspirin
  • Coronary Artery Disease
  • Coronary Restenosis
  • Drug-Eluting Stents
  • Female
  • Humans
  • International Cooperation
  • Long Term Adverse Effects
  • Male
  • Middle Aged
  • Outcome Assessment (Health Care)
  • Percutaneous Coronary Intervention
  • Platelet Aggregation Inhibitors
  • Practice Guidelines as Topic
  • Risk Factors
  • ST Elevation Myocardial Infarction
  • Ticlopidine
  • Journal Article
  • Multicenter Study
  • Observational Study

Cite this

Longer-term oral antiplatelet use in stable post-myocardial infarction patients : Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study. / Goodman, Shaun G; Nicolau, Jose C; Requena, Gema; Maguire, Andrew; Blankenberg, Stefan; Chen, Ji Yan; Granger, Christopher B; Grieve, Richard; Pocock, Stuart J; Simon, Tabassome; Yasuda, Satoshi; Vega, Ana Maria; Brieger, David; TIGRIS Study Investigators ; Marenzi, Giancarlo Silvio.

In: International Journal of Cardiology, Vol. 236, 01.06.2017, p. 54-60.

Research output: Contribution to journalArticle

Goodman, Shaun G ; Nicolau, Jose C ; Requena, Gema ; Maguire, Andrew ; Blankenberg, Stefan ; Chen, Ji Yan ; Granger, Christopher B ; Grieve, Richard ; Pocock, Stuart J ; Simon, Tabassome ; Yasuda, Satoshi ; Vega, Ana Maria ; Brieger, David ; TIGRIS Study Investigators ; Marenzi, Giancarlo Silvio. / Longer-term oral antiplatelet use in stable post-myocardial infarction patients : Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study. In: International Journal of Cardiology. 2017 ; Vol. 236. pp. 54-60.
@article{93f53fdc54bb4eeebb2a0de603facd05,
title = "Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study",
abstract = "OBJECTIVE: To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions.METHODS: Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96{\%} cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904).RESULTS: 9225 patients were enrolled (median 1.8years) post-MI: 52{\%} with prior ST-elevation MI, median age 67years, 24{\%} women, 67{\%} Caucasian, 55{\%} had ≥2 additional qualifying risk factors, 14{\%} current smokers, 67{\%} overweight/obese, 34{\%} with blood pressure ≥140/90mmHg. 81{\%} underwent percutaneous coronary intervention (PCI; 66{\%} with drug-eluting stents) for the index MI. 75{\%} of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75{\%}). 63{\%} had discontinued antiplatelet treatment (60{\%} ADPri) around 1year, most commonly by physician recommendation (90{\%}). At enrolment, 97{\%} were taking an antithrombotic drug, most commonly ASA (88{\%}), with 27{\%} on DAPT (median duration 1.6years); continued DAPT >1year was highest (39{\%}) in Asia-Pacific and lowest (12{\%}) in Europe.CONCLUSIONS: Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.",
keywords = "Aged, Aspirin, Coronary Artery Disease, Coronary Restenosis, Drug-Eluting Stents, Female, Humans, International Cooperation, Long Term Adverse Effects, Male, Middle Aged, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Practice Guidelines as Topic, Risk Factors, ST Elevation Myocardial Infarction, Ticlopidine, Journal Article, Multicenter Study, Observational Study",
author = "Goodman, {Shaun G} and Nicolau, {Jose C} and Gema Requena and Andrew Maguire and Stefan Blankenberg and Chen, {Ji Yan} and Granger, {Christopher B} and Richard Grieve and Pocock, {Stuart J} and Tabassome Simon and Satoshi Yasuda and Vega, {Ana Maria} and David Brieger and {TIGRIS Study Investigators} and Marenzi, {Giancarlo Silvio}",
note = "Copyright {\circledC} 2017 Elsevier Ireland Ltd. All rights reserved.",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.ijcard.2017.02.062",
language = "English",
volume = "236",
pages = "54--60",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Longer-term oral antiplatelet use in stable post-myocardial infarction patients

T2 - Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study

AU - Goodman, Shaun G

AU - Nicolau, Jose C

AU - Requena, Gema

AU - Maguire, Andrew

AU - Blankenberg, Stefan

AU - Chen, Ji Yan

AU - Granger, Christopher B

AU - Grieve, Richard

AU - Pocock, Stuart J

AU - Simon, Tabassome

AU - Yasuda, Satoshi

AU - Vega, Ana Maria

AU - Brieger, David

AU - TIGRIS Study Investigators

AU - Marenzi, Giancarlo Silvio

N1 - Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - OBJECTIVE: To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions.METHODS: Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904).RESULTS: 9225 patients were enrolled (median 1.8years) post-MI: 52% with prior ST-elevation MI, median age 67years, 24% women, 67% Caucasian, 55% had ≥2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥140/90mmHg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6years); continued DAPT >1year was highest (39%) in Asia-Pacific and lowest (12%) in Europe.CONCLUSIONS: Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.

AB - OBJECTIVE: To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions.METHODS: Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904).RESULTS: 9225 patients were enrolled (median 1.8years) post-MI: 52% with prior ST-elevation MI, median age 67years, 24% women, 67% Caucasian, 55% had ≥2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥140/90mmHg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6years); continued DAPT >1year was highest (39%) in Asia-Pacific and lowest (12%) in Europe.CONCLUSIONS: Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.

KW - Aged

KW - Aspirin

KW - Coronary Artery Disease

KW - Coronary Restenosis

KW - Drug-Eluting Stents

KW - Female

KW - Humans

KW - International Cooperation

KW - Long Term Adverse Effects

KW - Male

KW - Middle Aged

KW - Outcome Assessment (Health Care)

KW - Percutaneous Coronary Intervention

KW - Platelet Aggregation Inhibitors

KW - Practice Guidelines as Topic

KW - Risk Factors

KW - ST Elevation Myocardial Infarction

KW - Ticlopidine

KW - Journal Article

KW - Multicenter Study

KW - Observational Study

U2 - 10.1016/j.ijcard.2017.02.062

DO - 10.1016/j.ijcard.2017.02.062

M3 - Article

C2 - 28268087

VL - 236

SP - 54

EP - 60

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -