Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations

Jukema JW, Lettino M, Widimsky P, Danchin N et al.,
Eur Heart J Cardiovasc Pharmacother. First published online: 12 May 2015 DOI: http://dx.doi.org/10.1093/ehjcvp/pvv024

Acute coronary syndromes (ACS) are common in clinical practice, comprising ST-segment elevation myocardial infarction (STEMI), non-ST-segment myocardial infarction (NSTEMI), and unstable angina (UA). Percutaneous coronary intervention (PCI) is standard procedure for revascularisation in these patients. In the management of ACS, antiplatelet agents are also pivotal, since activation of platelets and their subsequent aggregation can propagate arterial thrombosis. Current guidelines recommend dual antiplatelet therapy (DAPT) consisting of aspirin plus one of the P2Y12 receptor inhibitors clopidogrel, prasugrel or ticagrelor, with the aim of reducing acute ischaemic complications and recurrent atherothrombotic events.

Multiple aspects of current management with DAPT in daily practice are captured in multiple registries, which represent an important source of real-world evidence (RWE). Registries usually include all consecutive patients, as opposed to highly selected patient populations in randomised clinical trials. Therefore, registries can fill important gaps in the available evidence, for instance on more complex high risk patients.

Because many European registries on clinical experience with ACS patients are small, PIRAEUS aims to combine these insights, in order to move beyond anecdotal evidence. This first article in a series describes the participating European registries, and the considerations, challenges and opportunities of such a project, as a prelude to upcoming articles that will analyse RWE clinical outcome data.

Find this article online at Eur Heart J Cardiovasc Pharmacother