Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention

Deepak L Bhatt; Juan Carlos Kaski; Sean Delaney; Mirvat Alasnag; Felicita Andreotti; Dominick J Angiolillo; Albert Ferro; Diana A Gorog; Alberto J Lorenzatti; Mamas Mamas; John McNeil; José C Nicolau; Philippe Gabriel Steg; Juan Tamargo; Doreen Tan; Marco Valgimigli

doi:10.1016/j.ijcard.2021.05.012

Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention

Int J Cardiol. 2021 Aug 15:337:1-8. doi: 10.1016/j.ijcard.2021.05.012. Epub 2021 May 15.

Authors

Deepak L Bhatt¹, Juan Carlos Kaski², Sean Delaney³, Mirvat Alasnag⁴, Felicita Andreotti⁵, Dominick J Angiolillo⁶, Albert Ferro⁷, Diana A Gorog⁸, Alberto J Lorenzatti⁹, Mamas Mamas¹⁰, John McNeil¹¹, José C Nicolau¹², Philippe Gabriel Steg¹³, Juan Tamargo¹⁴, Doreen Tan¹⁵, Marco Valgimigli¹⁶

Affiliations

¹ Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: [email protected].
² Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK. Electronic address: [email protected].
³ Radcliffe Cardiology Bourne End Business Park, Cores End Rd, Wooburn Green, Bourne End SL8 5AS, UK. Electronic address: [email protected].
⁴ King Fahd Armed Forces Hospital, Jeddah-KSA, Al Kurnaysh Rd, Al Andalus, Jeddah 23311, Saudi Arabia. Electronic address: [email protected].
⁵ Scientific Directorate, FPUG IRCCS, Rome, Italy; Cardiovascular Dept, Catholic University, Rome, Italy. Electronic address: [email protected].
⁶ University of Florida College of Medicine-Jacksonville, Division of Cardiology, ACC Building 5th floor 655 West 8th Street, Jacksonville, FL 32209, USA. Electronic address: [email protected].
⁷ King's College London, School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Research Excellence, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK. Electronic address: [email protected].
⁸ Faculty of Medicine, National Heart & Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK. Electronic address: [email protected].
⁹ Instituto Medico DAMIC, Av. Colon 2057, Cordoba, Argentina; Departamento de Cardiologia, Hospital Córdoba, Av. Patria 656, Córdoba, Argentina.
¹⁰ University Hospitals of North Midlands NHS Trust, Keel University, Staffordshire ST5 5BG, UK.
¹¹ School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton VIC, Melbourne 3800, Australia. Electronic address: [email protected].
¹² Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, Brazil. Electronic address: [email protected].
¹³ Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France. Electronic address: [email protected].
¹⁴ Faculty of Medicine of the Complutense University of Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Electronic address: [email protected].
¹⁵ Dept of Pharmacy, National University of Singapore, 8 Science Drive 4, 117543, Singapore. Electronic address: [email protected].
¹⁶ Inselspital, University Hospital Bern, Bern, Switzerland. Electronic address: [email protected].

PMID: 34000356
DOI: 10.1016/j.ijcard.2021.05.012

Abstract

Aims: Choosing an antiplatelet strategy in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) at high bleeding risk (HBR), undergoing post-percutaneous coronary intervention (PCI), is complex. We used a unique open-source approach (crowdsourcing) to document if practices varied across a small, global cross-section of antiplatelet prescribers in the post-PCI setting.

Methods and results: Five-hundred and fifty-nine professionals from 70 countries (the 'crowd') completed questionnaires containing single- or multi-option and free form questions regarding antiplatelet clinical practice in post-PCI NSTE-ACS patients at HBR. A threshold of 75% defined 'agreement'. There was strong agreement favouring monotherapy with either aspirin or a P2Y₁₂ inhibitor following initial DAPT, within the first year (94%). No agreement was reached on the optimal duration of DAPT or choice of monotherapy: responses were in equipoise for shorter (≤3 months, 51%) or longer (≥6 months, 46%) duration, and monotherapy choice (45% aspirin; 53% P2Y₁₂ inhibitor). Most respondents stated use of guideline-directed tools to assess risk, although clinical judgement was preferred by 32% for assessing bleeding risk and by 46% for thrombotic risk.

Conclusion: The crowdsourcing methodology showed potential as a tool to assess current practice and variation on a global scale and to achieve a broad demographic representation. These preliminary results indicate a high degree of variation with respect to duration of DAPT, monotherapy drug of choice following DAPT and how thrombotic and bleeding risk are assessed. Further investigations should concentrate on interrogating practice variation between key demographic groups.

Keywords: Antiplatelet therapy; Crowdsourcing; High bleeding risk; Non-ST segment elevation acute coronary syndrome; P2Y(12) receptor inhibitors; Percutaneous coronary intervention.

MeSH terms

Acute Coronary Syndrome* / diagnosis
Acute Coronary Syndrome* / drug therapy
Acute Coronary Syndrome* / epidemiology
Crowdsourcing*
Drug Therapy, Combination
Humans
Percutaneous Coronary Intervention* / adverse effects
Platelet Aggregation Inhibitors / adverse effects
Purinergic P2Y Receptor Antagonists / therapeutic use
Surveys and Questionnaires
Treatment Outcome

Substances

Platelet Aggregation Inhibitors
Purinergic P2Y Receptor Antagonists