Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study.

Authors:
Ajit Mullasari
Ajit Mullasari
Institute of Cardiovascular Diseases
India
Dhiman Kahali
Dhiman Kahali
SSKM Hospital and IPGME&R
Vimal Mehta
Vimal Mehta
GB Pant Hospital
India
Tiny Nair
Tiny Nair
PRS Hospital
India
Upendra Kaul
Upendra Kaul
Fortis Escorts Heart Institute

Indian Heart J 2019 Jan - Feb;71(1):25-31. Epub 2019 Jan 3.

Ruby Hospital, Pune, India.

Background: Acute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study.

Methods: EPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns.

Results: EPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients.

Conclusion: This study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S00194832183035
Publisher Site
http://dx.doi.org/10.1016/j.ihj.2018.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477169PMC
January 2019
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