Trends in use of anti-thrombotic agents and outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) managed with an invasive strategy

AbstractObjectiveTo analyze trends in utilization of anti-thrombotic agents (ATA) and in-hospital clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) patients managed with an invasive strategy from 2007 to 2010.Methods & resultsUsing ACTION Registry®-GWTG™ data, we analyzed trends in use of ATA and in-hospital clinical outcomes among 64,199 NSTEMI patients managed invasively between 2007 and 2010. ATA included unfractionated heparin (UFH), low molecular weight heparin (LMWH), glycoprotein IIb/IIIa inhibitors (GPI) and bivalirudin. Although the proportion of NSTEMI patients treated with PCI within 48h of hospital arrival was similar in 2007 and 2010, percentage use of bivalirudin (13.4–27.3%; p<0.01) and UFH increased (60.0–67.5%, p<0.01), and that of GPI (62.3–41.0%; p<0.01) and LMWH (41.5–36.8%; p<0.01) declined. Excess dosing of UFH (75.9–59.3%, p<0.01), LMWH (9.6–5.2%; p<0.01) and GPI (8.9–5.9%, p<0.01) was also significantly lower in 2010 compared with 2007. Though in-hospital mortality rates were similar in 2007 and 2010 (2.3–1.9%, p=0.08), the rates of in-hospital major bleeding (8.7–6.6%, p<0.01) and non-CABG related RBC transfusion (6.3–4.6%, p