Background: Data is limited regarding real life experience with the novel P2Y12 inhibitors. The aim of our study was to assess outcomes and implementation of novel P2Y12 inhibitors, in a large, unselected cohort of acute coronary syndrome (ACS) patients undergoing PCI.
Methods: Consecutive ACS patients who underwent PCI derived from the ACSIS registry were included. Patients were prospectively followed for 30 days for the occurrence of net adverse clinical outcome (NACE) composed of death, recurrent ACS, stent thrombosis, urgent revascularization, stroke, and major bleeding.
Results: A total of 1,262 patients were evaluated. Of these 512 (40.5%) were treated with clopidogrel, 483 (38.3%) with prasugrel, and 267(21.2%) with ticagrelor. Novel P2Y12 therapy was given in 77% of cases presenting with STEMI, while in patients presenting with NSTE - ACS only 51% received novel P2Y12 therapy. Compared to patients treated with novel P2Y12 inhibitors, patients treated with clopidogrel were older (69 vs. 60 p<0.001), more likely to be hypertensive (77% vs. 59% p<0.001), suffered more from chronic renal failure (21% vs. 9% p<0.001), and have a prior history stroke (12% vs. 5% p<0.01). Thirty days NACE was low and did not differ between patients treated with clopidogrel and those treated with the new anti-platelet agents (9.2% vs. 7.3% p=0.23). Similarly there were no significant differences in each of the components of the NACE including major bleeding (1% vs. 0.5% p=0.35) or stent thrombosis (1.2% vs. 1.6% p=0.52).
Conclusions: Outcomes among patients treated with clopidogrel were comparable to those treated with novel P2Y12 inhibitors. Yet, a significant amount of ACS patients undergoing PCI still receive therapy with clopidogrel, especially those which are older with more co-morbidities, and those presenting with NSTE-ACS.
