P2Y12 receptor inhibitors in patients with NSTE-ACS in the real world: use, patient selection, and outcomes from contemporary European registries

Zeymer U, Widimsky P, Danchin N, et al. on behalf of the PIRAEUS group
Eur Heart J Cardiovasc Pharmacother. First published online:2 March 2016

The Platelet inhibition Registry in ACS EvalUation Study (PIRAEUS) working group has published their third paper on real world data on P2Y12-receptor inhibitor use, based on contemporary European acute coronary syndrome (ACS) registries. As a follow-up to their initial methodology paper and the first data review paper on ST-segment elevation myocardial infarction (STEMI) patients, they now discuss non-ST-elevation acute coronary syndrome (NSTE-ACS).

Data of ten registries involving 84054 patients were available on outcomes in general, and six registries could provide data (52173 patients) specified based on the specific P2Y12-receptor inhibitor used. Heterogeneity was large for patient characteristics and outcome definition between registries, thus no formal meta-analysis could be performed.

In these NSTE-ACS patients, rates of death and other ischaemic events were comparable with or somewhat higher than those seen in phase III P2Y12-receptor inhibitor trials. The same was true for major bleedings. As compared with the STEMI cohorts in the same registries event rates shortly after the ACS event were lower.

Patient characteristics differed between those receiving clopidogrel, prasugrel or ticagrelor. Baseline characteristics suggest that product labelling of the individual P2Y12 receptor inhibitors were followed. Due to age differences between the therapy cohorts, and because adjustment for age would not be appropriate, outcomes cannot be compared between treatments.

The PIRAEUS NSTE-ACS study therefore mostly serves to provide an impression of current treatment strategy for NSTE across Europe. Future analyses aiming to compare data gathered in various registries would benefit from more standardisation of data collection.

Find this article online at Eur Heart J Cardiovasc Pharmacother.