BACKGROUND ACC/AHA guidelines support the use of the P2Y12 inhibitors clopidogrel, prasugrel, or ticagrelor in acute myocardial infarction (AMI). Little is known about trends in P2Y12 inhibitor selection over time. METHODS Multicenter, longitudinal analysis of patients and hospitals in the National Cardiovascular Data Registry (NCDR) Chest Pain - MI Registry from the third quarter of 2013 to the first quarter of 2017. RESULTS A total of 362,354 AMI patients treated at 801 hospitals were included in our analysis. Ticagrelor use increased over time, from 6.1% in 2013 to 33.7% in 2017, with corresponding reductions in the use of clopidogrel and prasugrel (p < 0.001 for all trends). In multivariable models, patients of white race, with private insurance, or STEMI were more likely to receive ticagrelor (p < 0.05 for all). Hospitals in the highest quartile of ticagrelor uptake had use rates ranging from 29% to 88%, and were more likely to have the lowest volume of MI patients. The correlation between prasugrel and ticagrelor adoption was weakly positive (correlation coefficient: 0.15, p = 0.004); hospitals with the lowest early adoption of prasugrel started with the lowest rate of ticagrelor use and had the slowest rate of increase in ticagrelor use. CONCLUSIONS There has been a rapid increase in use of ticagrelor since its approval by the FDA and both patient and hospital characteristics were associated with variation in its adoption and utilization. Further examination of the characteristics associated with the rapid adoption of new evidence may provide insights about improving health system performance.

中文翻译：

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急性心梗患者与替卡格雷吸收相关的患者和医院特征：胸痛-MI注册表分析。

背景技术ACC / AHA指南支持在急性心肌梗死（AMI）中使用P2Y12抑制剂氯吡格雷，普拉格雷或替卡格雷。关于P2Y12抑制剂选择随时间的变化趋势知之甚少。方法从2013年第三季度至2017年第一季度，对国家心血管数据注册中心（NCDR）胸痛-MI注册中心患者和医院进行多中心，纵向分析。结果总共纳入801，医院中的362,354例AMI患者我们的分析。随着时间的推移，替卡格雷的使用量从2013年的6.1％增长到2017年的33.7％，氯吡格雷和普拉格雷的使用量相应减少（所有趋势下的p <0.001）。在多变量模型中，白人，有私人保险或STEMI的患者更容易接受替卡格雷（p <0.05）。替卡格雷吸收率最高的四分之一医院的使用率在29％至88％之间，并且MI病人的数量最低的可能性更大。普拉格雷与替卡格雷的采用率之间呈弱正相关（相关系数：0.15，p = 0.004）；普拉格雷的早期采用率最低的医院开始使用替格瑞洛的比率最低，而替格瑞洛的增加比率却最慢。结论自从FDA批准替卡格雷洛以来，替卡格雷洛的使用迅速增加，患者和医院的特征均与替卡格雷洛的采用和使用差异有关。进一步检查与迅速采用新证据相关的特征可能会提供有关改善卫生系统性能的见解。