Antiplatelet strategy in the ARGEN-IAM Registry

Abstract

ARGEN-IAM-ST is a national, prospective, multicenter, observational registry, coordinated by the Argentine Society of Cardiology and the Argentine Federation of Cardiology. Material and methods: There were 3331 patients with ST elevation myocardial infarction
analyzed in the period 2015 to 2018. A descriptive analysis of the characteristics of the population, treatments performed, and differences between the patients treated with clopidogrel or with the new antiplatelet drugs (not clopidogrel: ticagrelor/prasugrel) was made. Results: The infarcts were located on the anterior wall in 1566 patients (47%), and another 1566 patients (47%) on the inferior wall. Reperfusion strategy was applied on 84% of the patients, with angioplasty of the culprit vessel in 86%. Door-to-balloon time was 117 (64-230) minutes, with only 26% of the angioplasties performed in the first 90 minutes after admission. The most widely used antiplatelet agent was clopidogrel (76%) and the remaining 24% was treated with the so-called “new antiplatelet agents” (prasugrel/ticagrelor). The greatest use of the “new antiaggregants” occurred in patients with prepaid or private health insurance (OR 5.1 (4.1-6.2), p<0.0001), in patients with previous angioplasty OR 1.5 (1.16-2) p = 0.02, diabetic patients OR
1.37 (1.12-1.68), p = 0.002, and those subjects in whom angioplasty was performed within the first 90 minutes after admission OR 3.0 (2.5-3.5) p <0.001. Clopidogrel was the preferred antiplatelet in ≥65 years. Overall mortality in clopidogrel-treated patients was 8.71%. Conclusions: In the ARGEN-IAM-ST registry, from 2015 to 2018, the reperfusion strategies used were different, preferably double antiaggregation with clopidogrel, with financial conditions probably preventing migration to the so-called “new antiplatelet drugs”. The higher in-hospital mortality rate in the group treated with clopidogrel should be a wake-up call in favor of considering the use of “new antiplatelet drugs”.