P939Cardiovascular outcomes in patients with Acute Coronary Syndrome and previous cardiovascular disease. An analysis from ACHILLES Registry
| Autor: | M Sandin Rollan, M A Esteve Pastor, Manuel J Macías-Villanego, José Miguel Rivera-Caravaca, Miriam Quintana-Giner, Francisco Marcos Marín, Antonio Tello-Montoliu, Teresa Lozano, Nuria Vicente-Ibarra, E Candela, Juan M. Ruiz-Nodar, Esteban Orenes-Piñero, Vicente Pernias-Escrig, L Carrillo-Aleman, A Veliz-Martinez |
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| Rok vydání: | 2019 |
| Předmět: |
Cardiovascular event
medicine.medical_specialty Acute coronary syndrome Achilles tendon business.industry Coronary arteriosclerosis Disease Clopidogrel medicine.disease medicine.anatomical_structure Internal medicine medicine Cardiology In patient Cardiology and Cardiovascular Medicine business Ticagrelor medicine.drug |
| Zdroj: | European Heart Journal. 40 |
| ISSN: | 1522-9645 0195-668X |
| Popis: | Background Patients with acute coronary syndrome (ACS) and previous cardiovascular disease (CVD) [stroke, peripheral arterial disease (PAD) or coronary artery disease (CAD)] are at high risk of serious events and mortality. Current clinical guidelines recommend new antiplatelet drugs (NAD) for high cardiovascular risk patients with ACS; however, these drugs are underused in different scenarios. Purpose The aim of this study was to analyze the use of NAD and advese events in patients with ACS an previous CVD. Methods ACHILLES registry is and observational, multicenter and prospective registry of ACS patients. 1717 ACS patients were consecutively included in this study from 3 tertiary Hospitals. Of them, 641 (37.33%) suffered from previous CVD: 149 patients with stroke, 154 patients with PAD and 541 patients with CAD. Bleeding, mortality and major adverse cardiac events (MACE) at 1 year of follow-up after hospital discharge were analyzed. Results NADs administration during hospital stay and at discharge was less frequent in patients with previous CVDs. Cox analysis in this cohort of patients showed that clopidogrel prescription at discharge was independently associated with MACEs [HR: 1.59 (95% CI 1.03–2.45); p=0.036] and with death [HR: 1.99 (95% CI 1.00–3.98); p=0.049] in multivariate analysis. More specifically, when ticagrelor prescription at discharge was compared with clopidogrel prescription, a significant death reduction was found in both, the univariate and the multivariate Cox analysis [HR: 4.54 (95% CI 2.26–9.13); p KM curves according NAD and CVD disease Conclusion New antiplatelet drugs, especially ticagrelor, showed lower rates of mortality in patients with CVD without differences for bleeding. Despite the recommendations of current clinical guidelines for high risk patients with ACS, the use of NADs is very low in “real-life” patients with previous CVD. |
| Databáze: | OpenAIRE |
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