ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)

Hamm, Christian W.; Bassand, Jean‐Pierre; Agewall, Stefan; Boersma, Eric; Bueno, Héctor; Caso, Pio; Dudek, Dariusz; Gielen, Stephan; Huber, Kurt; Öhman, Magnus; Petrie, Mark C; Sonntag, Frank; Uva, Miguel Sousa; Storey, Robert F.; Wijns, William; Zahger, Doron; Bax, Jeroen J.; Auricchio, Angelo; Baumgartner, Helmut; Ceconi, Claudio; Dean, Veronica; Deaton, Christi; Fagard, Robert; Funck‐Brentano, Christian; Hasdai, David; Hoes, Arno W.; Knuuti, Juhani; Kolh, Philippe; McDonagh, Theresa A.; Moulin, Cyril; Poldermans, Don; Popescu, Bogdan A.; Reiner, Željko; Sechtem, Udo; Sirnes, Per Anton; Torbicki, Adam; Vahanian, Alec; Windecker, Stephan; Achenbach, Stephan; Badimon, Lina; Bertrand, M; Bøtker, H.E.; Collet, Jean‐Philippe; Crea, Filippo; Danchin, N.; Falk, Erling; Goudevenos, John; Gulba, Dietrich C.; Hambrecht, Rainer; Herrmann, Joerg; Kastrati, Adnan; Kjeldsen, Keld; Kristensen, Steen Dalby; Lancellotti, Patrizio; Mehilli, Julinda; Merkely, Béla; Montalescot, Gilles; Neumann, F.-J.; Neyses, Ludwig; Perk, Joep; Roffi, Marco; Romeo, Francesco; Ruda, Mikhail; Swahn, Eva; Valgimigli, Marco; Vrints, Christian; Widimský, Petr

doi:10.1093/eurheartj/ehr236

Cited by 2,813 publications

(1,637 citation statements)

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“…Current treatment guidelines for patients with ACS undergoing percutaneous coronary intervention (PCI) recommend dual antiplatelet therapy (DAPT), a combination of aspirin and a P2Y 12 inhibitor, for at least 12 months after the ACS event 2, 3, 4, 5. Clopidogrel remains the most widely used P2Y 12 inhibitor.…”

Section: Introductionmentioning

confidence: 99%

“…Incremental benefit compared with clopidogrel has been shown with the more potent P2Y 12 inhibitors, prasugrel and ticagrelor, although at the risk of increased noncoronary artery bypass graft (CABG)‐related major bleeding 6, 7. Guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) for patients with non‐ST‐elevation (NSTE)‐ACS and ST‐elevation myocardial infarction (STEMI) recommend the use of ticagrelor or prasugrel over clopidogrel for patients with ACS undergoing PCI who can take these drugs safely 2, 3, 4, 5.…”

Section: Introductionmentioning

confidence: 99%

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“Real‐World” Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States

Larmore

Effron

Molife

et al. 2015

Cathet Cardio Intervent

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ObjectivesThe 30‐day clinical outcomes with prasugrel or ticagrelor were compared using a US payer database in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).BackgroundPrasugrel and ticagrelor demonstrated superior efficacy with increased non‐coronary artery bypass graft major bleeding compared with clopidogrel in randomized clinical trials. No direct randomized or observational studies have compared clinical outcomes between prasugrel and ticagrelor.MethodsPatients hospitalized for ACS‐PCI between August 1, 2011 and April 30, 2013 and prescribed prasugrel or ticagrelor were selected. Drug treatment cohorts were propensity matched based upon demographic and clinical characteristics. The primary objective compared 30‐day net adverse clinical events (NACE) in prasugrel‐ and ticagrelor‐treated patients using a prespecified 20% noninferiority margin. Secondary objectives included comparisons of major adverse cardiovascular events (MACE) and major bleeding.ResultsData were available for 16,098 patients (prasugrel, n = 13,134; ticagrelor, n = 2,964). In unmatched cohorts, prasugrel‐treated patients were younger with fewer comorbidities than ticagrelor‐treated patients, and 30‐day NACE rates were 5.6 and 9.3%, respectively (P < 0.001). Following propensity matching, NACE was noninferior (P < 0.001) and 22% lower in prasugrel‐treated than in ticagrelor‐treated patients (RR, 0.78; 95% CI, 0.64–0.94). A 30‐day adjusted MACE (RR, 0.80; 95% CI, 0.64–0.98) and major bleeding (RR, 0.65; 95% CI, 0.45–0.95) were also lower in prasugrel‐treated patients compared with ticagrelor‐treated patients.ConclusionsIn this “real‐world,” retrospective, observational study, physicians appear to preferentially use prasugrel in younger patients with lower risk of bleeding or comorbidities compared with ticagrelor. Following adjustment, clinical outcomes associated with prasugrel use appear as good, if not better, than those associated with ticagrelor in ACS‐PCI patients. © 2015 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Real‐World” Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States

Larmore

Effron

Molife

et al. 2015

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…These recommendations are mainly based on evidence from the Percutaneous Coronary Intervention‐Clopidogrel in Unstable angina to prevent Recurrent Events (PCI‐CURE)5 and the Clopidogrel for the Reduction of Events During Observation (CREDO) trials,25 which were conducted more than a decade ago and may not represent contemporary practice trends. In these studies, most of the patients had their PCIs postponed for up to several days after pretreatment, whereas current practice often leads to invasive treatment within hours of first medical contact.…”

Section: Discussionmentioning

confidence: 99%

Variation in Practice Regarding Pretreatment With Dual Antiplatelet Therapy for Patients With Non–ST Elevation Myocardial Infarction

Shafiq

Valle

Jang

et al. 2016

JAHA

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BackgroundDespite guideline recommendations, a significant number of patients with non–ST elevation myocardial infarction (NSTEMI) do not receive dual antiplatelet therapy (DAPT) before angiography “pretreatment.” While there may be valid clinical reasons to not pretreat, such as concern for bleeding or multivessel disease warranting coronary artery bypass graft surgery, the degree of variability and factors associated with DAPT pretreatment are unknown.Methods and ResultsFrom the multicenter TRIUMPH registry, 1632 NSTEMI patients were not taking DAPT on admission and were included in the study cohort. Among the study patients, only 22% patients received DAPT pretreatment. A multivariable logistic regression model showed that race other than white or black (odds ratio [OR] 0.41, 95% CI 0.21–0.83), hemoglobin level (OR 1.18, 95% CI 1.08–1.29), patients’ bleeding risk (assessed with NCDR CathPCI Bleeding Risk Score) (OR 0.85, 95% CI 0.74–0.99), and severe left ventricular dysfunction (OR 0.3, 95% CI 0.13–0.65) were the main predictors of pretreatment with DAPT, whereas likelihood of needing coronary artery bypass graft surgery (GRACE prediction model) was not (OR 1.09, 95% CI 0.88–1.35). Median ORs were calculated to assess variability of receiving DAPT pretreatment across sites after adjustment for patient characteristics. Receiving DAPT pretreatment varied substantially across sites (range 0–100%, mean OR 3.94, P<0.0001).ConclusionsWhile deviating from guideline‐recommended DAPT pretreatment in patients with NSTEMI was associated with patient factors (eg, bleeding risk), marked variation was present across sites after accounting for patient‐level characteristics. This suggests that site‐level interventions are needed to improve concordance with current guidelines.

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“…in the case of mitral or aortic valve regurgitation, a leakage of at least grade 3 or 4). Coronary artery disease was defined as present if medical records revealed information of previous myocardial infarction or revascularization and if the patient's symptomology, coronary angiography, echocardiography, electrocardiogram, or laboratory reports contained supporting data in accordance with ESC guidelines 15, 16, 17. Data about alcohol and/or drug abuse found in the records were recorded.…”

Section: Methodsmentioning

confidence: 99%

High validity of cardiomyopathy diagnoses in western Sweden (1989–2009)

et al. 2017

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AimHospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods.Methods and resultsEvery fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Västra Götaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non‐compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as ‘other cardiomyopathies’. Relevant co‐morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co‐morbidities differ.ConclusionsThe accuracy rate of the cardiomyopathy diagnoses from in‐hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no significant difference in co‐morbidities during the study period. The accuracy rate of the cardiomyopathy diagnoses during the 20 year period was high. The use of diagnostic tools did not increase under the study period, and once cardiomyopathy diagnoses were suspected, echocardiography was performed in almost all cases. In this study, the occurrence of cardiomyopathy was increasing over time without significant increase of co‐morbidity, supporting that an actual increase of cardiomyopathy has occurred.

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ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)

Cited by 2,813 publications

References 348 publications

“Real‐World” Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States

“Real‐World” Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States

Variation in Practice Regarding Pretreatment With Dual Antiplatelet Therapy for Patients With Non–ST Elevation Myocardial Infarction

High validity of cardiomyopathy diagnoses in western Sweden (1989–2009)

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