Contemporary utilization patterns of P2Y12 inhibitors show a steady increase in prescription of ticagrelor at discharge after an acute myocardial infarction (AMI), according to a study using ACC's Chest Pain – MI Registry data. The study also found significant compliance with the ACC/AHA guideline recommendation of low-dose aspirin in patients treated with ticagrelor. The results were published in the Journal of the American Heart Association.

Sukhdeep S. Basra, MD, MPH, et al., evaluated temporal trends in P2Y12 prescriptions in 167,455 patients treated for AMI at 622 sites from October 2013 through December 2014. They found the prescription rate for ticagrelor increased from 12 percent to 16.7 percent, there was a decrease in the prescription of clopidogrel from 54.2 percent to 51.1 percent and in prasugrel from 15.7 percent to 13.9 percent (p<0.0001 for all).

The independent factors associated with prescribing ticagrelor rather than clopidogrel included younger age, white race, home ticagrelor use, invasive management, and inhospital reinfarction and stroke (p<0.0001 for all). For prescribing ticagrelor over prasugrel, the independent factors included older age, female sex, prior stroke, home ticagrelor use and inhospital stroke (p<0.0001 for all).

Among the 21,262 patients discharged on ticagrelor plus aspirin, high-dose aspirin was prescribed for 3.1 percent. Independent factors associated with prescribing high-dose aspirin were home aspirin use, diabetes, previous MI, previous CABG, STEMI, cardiogenic shock and geographic region (p=0.01).

"Our contemporary report shows a modest but significant increase in the use of ticagrelor early and at discharge, with simultaneous decline in the use of clopidogrel and prasugrel in patients presenting with AMI," the authors conclude. In addition, they explain that an increased use of low-dose aspirin at discharge in patients treated with ticagrelor was demonstrated. Yet, the significant regional and hospital variability in ticagrelor prescription and aspirin dose at discharge "represent[s] important opportunities for future improvements in care of patients with AMI."

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Chest Pain MI Registry, Aspirin, Shock, Cardiogenic, American Heart Association, Ticlopidine, Adenosine, Myocardial Infarction, Patient Discharge, Stroke, Registries, National Cardiovascular Data Registries, Diabetes Mellitus

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