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Switching between thienopyridines in patients with acute myocardial infarction and quality of care

Abstract : Objective - In acute coronary syndromes, switching between thienopyridines is frequent. The aims of the study were to assess the association between switching practices and quality of care. Methods - Registry study performed in 213 French public university, public non-academic and private hospitals. All consecutive patients admitted for acute myocardial infarction (MI; <48 hours) between 1/10/2010 and 30/11/2010 were eligible. Clinical and biological data were recorded up to 12 months follow-up. Results - Among 4101 patients receiving thienopyridines, a switch was performed in 868 (21.2%): 678 (16.5%) from clopidogrel to prasugrel and 190 (4.6%) from prasugrel to clopidogrel. Predictors of switch were ST segment elevation MI presentation, admission to a cardiology unit, previous percutaneous coronary intervention, younger age, body weight >60 kg, no history of stroke, cardiac arrest, anaemia or renal dysfunction. In patients with a switch, eligibility for prasugrel was >82% and appropriate use of a switch was 86% from clopidogrel to prasugrel and 20% from prasugrel to clopidogrel. Quality indicators scored higher in the group with a switch and also in centres where the switch rate was higher. Conclusions - As applied in the French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction (FAST-MI) registry, switching from one P2Y12 inhibitor to another led to a more appropriate prescription and was associated with higher scores on indicators of quality of care.
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Submitted on : Monday, February 13, 2017 - 10:44:44 AM
Last modification on : Wednesday, June 1, 2022 - 3:54:07 AM

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F. Schiele, Etienne Puymirat, Laurent Bonello, Nicolas Meneveau, Jean-Philippe Collet, et al.. Switching between thienopyridines in patients with acute myocardial infarction and quality of care. Open heart, British Cardiovascular Society, 2016, 3 (1), pp.e000384. ⟨10.1136/openhrt-2015-000384⟩. ⟨hal-01465836⟩



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