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Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes : insights from EPICOR, an international study of current practice patterns

Héctor Bueno, Peter Sinnaeve, Lieven Annemans UGent, Nicolas Danchin, Muriel Licour, Jesús Medina, Stuart Pocock, Joaquín Sánchez-Covisa, Robert F Storey, J Wouter Jukema, et al. (2016) EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. 5(1). p.3-12
abstract
Aims: To describe international patterns and opportunities for improvement of pre- and in-hospital care of patients hospitalized for acute coronary syndromes (ACS), with special focus on anti-thrombotic therapy. Methods and results: EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients), an international, cohort study, which enrolled 10,568 consecutive ACS survivors from 555 hospitals in 20 countries across Europe and Latin America (September 2010 to March 2011), prospectively registered detailed information on pre- and in-hospital management. Globally, 4738 (44.8%) were attended before hospitalization, 4241 (40.1%) had an ECG, 2119 (20%) received anti-platelet therapy and 101 STEMI patients (2%) fibrinolysis. In-hospital, 7944 patients (75.2%) received dual anti-platelet therapy, most often with clopidogrel (69.7%), and less with prasugrel (5.4%); 1705 (16.1%) had triple anti-platelet therapy, and 849 (8%) single anti-platelet therapy. STEMI patients more often received pre-hospital anti-thrombotics, and prasugrel, GP IIb/IIIa inhibitors and UFH in-hospital (all p < 0.001). More NSTE-ACS patients received clopidogrel, single anti-platelet therapy, and fondaparinux (all p < 0.001). As many as 33% of ACS patients were medically managed. A significant decreasing gradient was found between Northern, Southern and Eastern Europe and Latin America in use of more potent patterns of anti-platelet therapy, reperfusion therapy and invasive strategy. Conclusion: This large international study shows room for improvement in use of anti-thrombotic drugs and other strategies for optimal management of ACS, including pre-hospital ECG and anti-thrombotic therapy. Regional practice differences not based on evidence or conditioned by economic constraints should be reduced.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
anti-platelet drugs, Acute coronary syndromes, anti-coagulants, real-world, ST-SEGMENT ELEVATION, ACUTE MYOCARDIAL-INFARCTION, ASSOCIATION TASK-FORCE, PRACTICE GUIDELINES, GLOBAL REGISTRY, EVENTS GRACE, PRETREATMENT
journal title
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
Eur. Heart J.-Acute Cardiovasc. Care
volume
5
issue
1
pages
3 - 12
ISSN
2048-8726
DOI
10.1177/2048872614565912
language
English
UGent publication?
yes
classification
A2
copyright statement
I have transferred the copyright for this publication to the publisher
id
7167277
handle
http://hdl.handle.net/1854/LU-7167277
date created
2016-03-30 09:52:44
date last changed
2017-08-01 09:09:48
@article{7167277,
  abstract     = {Aims: To describe international patterns and opportunities for improvement of pre- and in-hospital care of patients hospitalized for acute coronary syndromes (ACS), with special focus on anti-thrombotic therapy.
Methods and results: EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients), an international, cohort study, which enrolled 10,568 consecutive ACS survivors from 555 hospitals in 20 countries across Europe and Latin America (September 2010 to March 2011), prospectively registered detailed information on pre- and in-hospital management. Globally, 4738 (44.8\%) were attended before hospitalization, 4241 (40.1\%) had an ECG, 2119 (20\%) received anti-platelet therapy and 101 STEMI patients (2\%) fibrinolysis. In-hospital, 7944 patients (75.2\%) received dual anti-platelet therapy, most often with clopidogrel (69.7\%), and less with prasugrel (5.4\%); 1705 (16.1\%) had triple anti-platelet therapy, and 849 (8\%) single anti-platelet therapy. STEMI patients more often received pre-hospital anti-thrombotics, and prasugrel, GP IIb/IIIa inhibitors and UFH in-hospital (all p {\textlangle} 0.001). More NSTE-ACS patients received clopidogrel, single anti-platelet therapy, and fondaparinux (all p {\textlangle} 0.001). As many as 33\% of ACS patients were medically managed. A significant decreasing gradient was found between Northern, Southern and Eastern Europe and Latin America in use of more potent patterns of anti-platelet therapy, reperfusion therapy and invasive strategy.
Conclusion: This large international study shows room for improvement in use of anti-thrombotic drugs and other strategies for optimal management of ACS, including pre-hospital ECG and anti-thrombotic therapy. Regional practice differences not based on evidence or conditioned by economic constraints should be reduced.},
  author       = {Bueno, H{\'e}ctor and Sinnaeve, Peter and Annemans, Lieven and Danchin, Nicolas and Licour, Muriel and Medina, Jes{\'u}s and Pocock, Stuart and S{\'a}nchez-Covisa, Joaqu{\'i}n and Storey, Robert F and Jukema, J Wouter and Zeymer, Uwe and Van de Werf, Frans},
  issn         = {2048-8726},
  journal      = {EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE},
  keyword      = {anti-platelet drugs,Acute coronary syndromes,anti-coagulants,real-world,ST-SEGMENT ELEVATION,ACUTE MYOCARDIAL-INFARCTION,ASSOCIATION TASK-FORCE,PRACTICE GUIDELINES,GLOBAL REGISTRY,EVENTS GRACE,PRETREATMENT},
  language     = {eng},
  number       = {1},
  pages        = {3--12},
  title        = {Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes : insights from EPICOR, an international study of current practice patterns},
  url          = {http://dx.doi.org/10.1177/2048872614565912},
  volume       = {5},
  year         = {2016},
}

Chicago
Bueno, Héctor, Peter Sinnaeve, Lieven Annemans, Nicolas Danchin, Muriel Licour, Jesús Medina, Stuart Pocock, et al. 2016. “Opportunities for Improvement in Anti-thrombotic Therapy and Other Strategies for the Management of Acute Coronary Syndromes : Insights from EPICOR, an International Study of Current Practice Patterns.” European Heart Journal-acute Cardiovascular Care 5 (1): 3–12.
APA
Bueno, Héctor, Sinnaeve, P., Annemans, L., Danchin, N., Licour, M., Medina, J., Pocock, S., et al. (2016). Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes : insights from EPICOR, an international study of current practice patterns. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, 5(1), 3–12.
Vancouver
1.
Bueno H, Sinnaeve P, Annemans L, Danchin N, Licour M, Medina J, et al. Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes : insights from EPICOR, an international study of current practice patterns. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. 2016;5(1):3–12.
MLA
Bueno, Héctor, Peter Sinnaeve, Lieven Annemans, et al. “Opportunities for Improvement in Anti-thrombotic Therapy and Other Strategies for the Management of Acute Coronary Syndromes : Insights from EPICOR, an International Study of Current Practice Patterns.” EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 5.1 (2016): 3–12. Print.