Patras University Hospital, Department of Cardiology, Patras, Greece.
Int J Cardiol. 2013 Oct 15;168(6):5329-35. doi: 10.1016/j.ijcard.2013.08.007. Epub 2013 Aug 15.
Few data exist about the implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
GReek AntiPlatelet rEgistry (GRAPE), initiated on January 2012, is a prospective, observational, multicenter cohort study focusing on contemporary use of P2Y12 inhibitors. In 1434 patients we evaluated appropriateness of P2Y12 selection initially and at discharge by applying an eligibility-assessing algorithm based on P2Y12 inhibitors' contraindications/specific warnings and precautions.
Appropriate, less preferable and inappropriate P2Y12 inhibitor selections were made initially in 45.8%, 47.2% and 6.6% and at discharge in 64.1%, 29.2% and 6.6% of patients, respectively. The selection of clopidogrel was most commonly less preferable, both initially (69.7%) and at discharge (75.6%). Appropriate selection of newer agents was high initially (79.2%-82.8%), with further increase as selection at discharge (89.4%-89.8%). Inappropriate selection of the newer agents was 17.2%-20.8% initially, decreasing to 10.2%-10.6% at discharge. Conditions and co-medications related to increased bleeding risk, presentation with ST elevation myocardial infarction and the absence of reperfusion within the first 24h were the most powerful predictors of appropriate P2Y12 selection initially, whereas age ≥75 years, conditions and co-medications related to increased bleeding risk and regional trends mostly affected appropriate P2Y12 selection at discharge.
In GRAPE, adherence with the recently released guidelines on oral antiplatelet therapy was satisfactory. Clopidogrel was most commonly used as a less preferable selection, while prasugrel or ticagrelor selection was mostly appropriate. Certain factors may predict initial and at discharge guideline implementation. Clinical Trial Registration-clinicaltrials.gov Identifier: NCT01774955 http://clinicaltrials.gov/.
关于接受经皮冠状动脉介入治疗（PCI）的急性冠脉综合征（ACS）患者中，当代口服抗血小板治疗指南的实施情况，相关数据很少。
希腊抗血小板注册研究（GRAPE）于 2012 年 1 月启动，是一项前瞻性、观察性、多中心队列研究，重点关注 P2Y12 抑制剂的当代应用。我们在 1434 例患者中评估了 P2Y12 选择的适宜性，最初通过应用基于 P2Y12 抑制剂禁忌/特殊警告和注意事项的合格评估算法进行评估，然后在出院时再次评估。
最初和出院时，合适、不太理想和不合适的 P2Y12 抑制剂选择分别为 45.8%、47.2%和 6.6%，64.1%、29.2%和 6.6%。氯吡格雷最初（69.7%）和出院时（75.6%）的选择最常见的是不太理想。最初（79.2%-82.8%）和出院时（89.4%-89.8%）新型药物的选择较为合适。最初新型药物的不适当选择为 17.2%-20.8%，出院时降至 10.2%-10.6%。与出血风险增加相关的情况和合并用药、ST 段抬高型心肌梗死的表现以及 24 小时内无再灌注是最初适当选择 P2Y12 的最有力预测因素，而年龄≥75 岁、与出血风险增加相关的情况和合并用药以及区域趋势主要影响出院时适当选择 P2Y12。
在 GRAPE 中，口服抗血小板治疗的新指南得到了很好的遵循。氯吡格雷最常被用作不太理想的选择，而普拉格雷或替格瑞洛的选择大多是合适的。某些因素可能预测初始和出院时指南的实施。临床试验注册-ClinicalTrials.gov 标识符：NCT01774955http://clinicaltrials.gov/。
