ep wire on european management strategy for acute coronary ... · ep wire on european management...

EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in

1/31

80,85% 38

6,38% 3

12,77% 6

Q1IsyourInstitution:Répondues:47 Ignorées:0

Total 47

Auniv ersityhospital

Apriv atehospital

Othertypeofhospital

0% 20% 40% 60% 80% 100%

Choixderéponses Réponses

Auniversityhospital

Aprivatehospital

Othertypeofhospital


2/31

Q2YouremailAddressis:Répondues:45 Ignorées:2


3/31

95,74% 45

4,26% 2

Q3WouldyoubecomfortableifweacknowledgeyourcentreintheEuropace

JournalandontheWebsiteRépondues:47 Ignorées:0

Total 47

Yes

No

0% 20% 40% 60% 80% 100%


Yes

No


4/31

80,85% 38

19,15% 9

Q4Doyouhavecardiacsurgeryatyourinstitution

Répondues:47 Ignorées:0

Total 47

Yes

No

0% 20% 40% 60% 80% 100%


Yes

No


5/31

2,13% 1

10,64% 5

8,51% 4

42,55% 20

36,17% 17

Q5Numberofimplantations(sumofnewimplantsandreplacements)atyour

institutionlastcalendaryear:Répondues:47 Ignorées:0

Total 47

None

1-99

100-199

200-399

400ormore

0% 20% 40% 60% 80% 100%


None

1-99

100-199

200-399

400ormore


6/31

10,64% 5

19,15% 9

14,89% 7

34,04% 16

21,28% 10

Q6TotalNumberofcatheterablations(alltypesofarrhythmia)atyourinstitutionlast

calendaryear:Répondues:47 Ignorées:0

Total 47

None

1-99

100-199

200-399

400ormore

0% 20% 40% 60% 80% 100%


None

1-99

100-199

200-399

400ormore


7/31

4,26% 2

8,51% 4

19,15% 9

57,45% 27

10,64% 5

Q7NumberofPacemakerimplantations(IncludingCRT-Ps)atyourinstitution

(includingboxchanges)lastcalendaryearRépondues:47 Ignorées:0

Total 47

None

1-99

100-199

200-399

400ormore

0% 20% 40% 60% 80% 100%


None

1-99

100-199

200-399

400ormore


8/31

4,65% 2

6,98% 3

6,98% 3

23,26% 10

58,14% 25

Q8Numberofinvasivecoronaryinterventionprocedures

(angioplasty/stenting)peryearinyourinstitutionaverages:


Total 43

None

Upto100

101–500

501–1000

>1000

0% 20% 40% 60% 80% 100%


None

Upto100

101–500

501–1000

>1000


9/31

25,58% 11

48,84% 21

9,30% 4

16,28% 7

Q9HowmanyAFpatientsonNOACs(i.e.,dabigatran,rivaroxabanorapixaban)who

sufferedanacutecoronarysyndrome(ACS)haveyouseeninyourclinical

practicesofar?Répondues:43 Ignorées:4

Total 43

None

≤50patients

51-100patients

>100patients

0% 20% 40% 60% 80% 100%


None

≤50patients

51-100patients

>100patients


10/31

Q10WhatisthepreferredstrategyinyourcentreforAFpatientspresentingwithSTEMIwithinanoptimaltimeframefor

intervention,whoarealreadytakingwarfarinoraNOAC?



11/31

ForAFpatientstakingaVitaminKantagonist(VKA)

PrimaryPCIwithuninterruptedwarfarinregardlessoftheINRvalue

PrimaryPCIwithuninterruptedwarfarinonlyiftheINRisbelow(please,statethecut-offvalue)

Fibrinolytic therapy Conservativetreatment

Oneanswerpersection

0% 20% 40% 60% 80% 100%


12/31

ForAFpatientstakingaVitaminKantagonist(VKA)

58,14% 34,88% 6,98% 0% 43

ForAFpatientstakinganoveloralanticoagulant(NOAC)

PrimaryPCIwithuninterruptedNOAC

PrimaryPCIwithtemporaryNOACdiscontinuation Fibrinolytic therapy

Conservativetreatment

Oneanswerpersection

0% 20% 40% 60% 80% 100%

PrimaryPCIw ithuninterruptedwarfarinregardlessoftheINRv alue

PrimaryPCIw ithuninterruptedwarfarinonlyiftheINRisbelow(please,statethecut-offv alue)

Fibrinolytictherapy

Conserv ativ etreatment

Total

One


13/31

58,14%25

34,88%15

6,98%3

0%0

43

ForAFpatientstakinganov eloralanticoagulant(NOAC)

37,21%16

55,81%24

6,98%3

0%0

43

Oneanswerpersection

PrimaryPCIw ithuninterruptedNOAC

PrimaryPCIw ithtemporaryNOACdiscontinuation

Fibrinolytictherapy

Conserv ativ etreatment

Total

Oneanswerpersection


14/31

4,65% 2

83,72% 36

69,77% 30

23,26% 10

32,56% 14

6,98% 3

2,33% 1

Q11Whichperi-proceduralantithromboticmedicationdoyoupreferablychoosefor

yourAFpatientsalreadyunderVKAtreatmentundergoingprimaryPCIfor

STEMI(please,tickallmedicationsyouuseontopofaVKA):Répondues:43 Ignorées:4

Nombretotalderépondants:43

Noadditional

antithromb...

Aspirin

Clopidogrel

PrasugrelorTicagrelor

Heparin(unfractionatedorLMWH)

GPIIb/IIIainhibitors

Idonotpersonallyperform...

0% 20% 40% 60% 80% 100%


Noadditionalantithrombotic medication

Aspirin

Clopidogrel




Idonotpersonallyperforminvasivecoronaryprocedures(angioplasty/stenting)andcannotanswerthisquestion


15/31

11,63% 5

74,42% 32

67,44% 29

16,28% 7

30,23% 13

9,30% 4

2,33% 1

Q12Whichperi-proceduralantithromboticmedicationdoyoupreferablychooseforyourAFpatientsunderNOACtreatment

undergoingprimaryPCIforSTEMI(please,tickallmedicationsyouuseontopofa

NOAC):Répondues:43 Ignorées:4


Noadditional

antithromb...

Aspirin

Clopidogrel




Idonotpersonallyperform...

0% 20% 40% 60% 80% 100%



Aspirin

Clopidogrel




Idonotpersonallyperforminvasivecoronaryprocedures(angioplasty/stenting)andcannotanswerthisquestion


16/31

35,90% 14

10,26% 4

20,51% 8

33,33% 13

Q13DoyouroutinelytemporarilystoporalanticoagulanttherapyinyourAFpatient

presentingwithanNSTE-ACS?Répondues:39 Ignorées:8

Total 39

Yes,always

Yes,aVKA

Yes,aNOAC

No

0% 20% 40% 60% 80% 100%


Yes,always

Yes,aVKA

Yes,aNOAC

No


17/31

Q14HowdoyoucommonlyestimatetherisksofAF-relatedthromboembolic

events,ischemiceventsandbleedinginAFpatientspresentingwithaNSTE-ACS?


Usingcommon

clinicalsense

TheGRACEscore

TheTIMIscore

TheCRUSADE

score

TheACUITY/HORIZONSderiv ed...

TheCHADS2score


18/31

61,11%11

77,78%14

61,11%11

36

17,65%3

82,35%14

0%0

17

0%0

73,33%11

33,33%5

16

0%0

25%1

75%3

4

0%0

50%2

50%2

4

100%9

0%0

11,11%1

10

100%36

16,67%6

5,56%2

44

2,94%1

0%0

97,06%33

34

0%0

0%0

0%0

0

TheriskofAF-relatedthromboembolic events Theriskofischemicevents

Theriskofbleeding

TheCHA2DS2-

VAScscore

TheHAS-BLEDscore

Other(please,

state)

0% 20% 40% 60% 80% 100%

TheriskofAF-relatedthromboembolicev ents

Theriskofischemicev ents

Theriskofbleeding

Nombretotalderépondants

Usingcommonc linicalsense

TheGRACEscore

TheTIMIscore

TheCRUSADEscore

TheACUITY/HORIZONSderivedscore

TheCHADS2score

TheCHA2DS2-VAScscore

TheHAS-BLEDscore

Other(please,state)


19/31

0% 0

76,92% 30

74,36% 29

17,95% 7

30,77% 12

0% 0

Q15Whatfirst-linepharmacologicaltherapydoyoupreferablyuseinAF

patientspresentingwithaNSTE-ACSwhoarealreadytakingaVKAoraNOAC

(please,tickallmedicationsyouuse):Répondues:39 Ignorées:8


Noadditional

antithromb...

Aspirin

Clopidogrel




0% 20% 40% 60% 80% 100%



Aspirin

Clopidogrel





20/31

17,95% 7

38,46% 15

43,59% 17

Q16Whichaccessroute(puncturesite)isusedatyourcentreinAFpatientsona

VKA/NOAC,undergoingcoronaryangiographyoraPCIwithstenting?


Total 39

Femoral

Radial,always

Radial,iftheoperator

hasadequa...

0% 20% 40% 60% 80% 100%


Femoral

Radial,always

Radial,i ftheoperatorhasadequateexperience


21/31

0% 0

12,82% 5

12,82% 5

53,85% 21

2,56% 1

15,38% 6

2,56% 1

Q17WhichstenttypeispreferablyusedatyourcentreforprimaryPCIinAFpatients

withSTEMI,takingaVKA/NOAC?Répondues:39 Ignorées:8

Total 39

OtherStent(seebelow)

Drug-elutingstents

Drug-elutingstents,if

therisko...

Bare-metalstents

Otherstents(please,

statewhic...

Wedonothav ea

specific...

Other(Seebelow)

0% 20% 40% 60% 80% 100%


OtherStent(seebelow)

Drug-elutingstents

Drug-elutingstents,iftheriskofbleedingwithsubsequenttripletherapyisnottoohigh

Bare-metalstents

Otherstents(please,statewhichone)

Wedonothaveaspecific strategyforthesepatients

Other(Seebelow)


22/31

25,64% 10

74,36% 29

17,95% 7

15,38% 6

10,26% 4

Q18Whichofthefollowingtreatmentmodalitiesdoyouuseinyourclinical

practiceregardingAFpatientspresentingwithaNSTE-ACS,whoaretakinga

VKA/NOAC?Répondues:39 Ignorées:8


Inv asiv estrategies

(coronary...

Bare-metalstentsare

preferred...

Soleballoonangioplastyinsteadof...

Bypasssurgery

insteadof...

Nospecificmeasure

taken

0% 20% 40% 60% 80% 100%


Invasivestrategies(coronaryangiographyandrevascularization)shouldbedelayedaslongaspossibleinsuchpatients

Bare-metalstentsarepreferredabovedrug-elutingstentstoshortenexposuretodualortripletherapy

SoleballoonangioplastyinsteadofstentimplantationshouldbeconsideredinAFpatientsathighbleedingriskrequiringtripletherapy

BypasssurgeryinsteadofPCIstentingshouldbeconsideredinAFpatientsathighbleedingriskwithtripletherapy

Nospecific measuretaken


23/31

41,03%16

15,38%6

28,21%11

15,38%6

Q19Doyouroutinelycontinuewithtripletherapy(thatis,anoralanticoagulantplustwoantiplateletdrugs)inallpatientswithAFandSTEMIwhounderwentPCIwith

stenting?Répondues:39 Ignorées:8

Total 39

Yes

No,Iusetriple

therapyon...

No,Iusetriple

therapyon...

No,Iusetriple

therapyon...

0% 20% 40% 60% 80% 100%


Yes

No,IusetripletherapyonlyinAFpatientsatmoderate-to-highriskofthromboembolic eventsregardlessofthebleedingrisk.

No,IusetripletherapyonlyinAFpatientsatmoderate-to-highriskofthromboembolic eventsiftheriskofbleedingisnottoohigh

No,IusetripletherapyonlyinAFpatientswithdrug-elutingstentsatmoderate-to-highriskofthromboembolic eventsiftheriskofbleedingisnottoohigh.


24/31

Q20Whichcombination(s)offollowingdrugsdoyoupreferablyusefortriple

therapyinyourAFpatientsafteranACS?(please,tickalloptionsyouwouldchoose)


Warfarin(orotherVKA)withtheI...

Warfarin(orotherVKA)withtheI...

Dabigatran150mgbid

Dabigatran110mgbid

Riv aroxaban20mgonce

daily

Riv aroxaban15mgonce

daily


25/31

88,24%30

17,65%6

20,59%7

43

81,25%13

18,75%3

25%4

20

77,78%7

22,22%2

22,22%2

11

87,50%14

12,50%2

12,50%2

18

75%6

37,50%3

37,50%3

12

83,33%10

25%3

16,67%2

15

75%3

50%2

25%1

6

90,91%10

18,18%2

9,09%1

13

Aspirin+Clopidogrel Aspirin+Prasugrel Aspirin+Ticagrelor

Apixaban5mg

bid

Apixaban2.5mgbid

0% 20% 40% 60% 80% 100%

Aspirin+Clopidogrel

Aspirin+Prasugrel

Aspirin+Ticagrelor

Nombretotalderépondants

Warfarin(orotherVKA)withtheINR2.0-2.5

Warfarin(orotherVKA)withtheINR2.0-3.0

Dabigatran150mgbid

Dabigatran110mgbid

Rivaroxaban20mgoncedaily

Rivaroxaban15mgoncedaily

Apixaban5mgbid

Apixaban2.5mgbid


26/31

15,38%6

84,62%33

Q21HowlongdoyoucontinuetripletherapyinAFpatientsafterprimaryPCI

withstenting?Répondues:39 Ignorées:8

Total 39

9-12months,regardlessof

thebleedi...

Atleast1monthfor

bare-metal...

0% 20% 40% 60% 80% 100%


9-12months,regardlessofthebleedingrisk

Atleast1monthforbare-metalstentsandatleast3-6monthsfordrug-elutingstents(dependingonthestenttype),particularlyiftheriskofbleedingishigh


27/31

58,97% 23

25,64% 10

15,38% 6

Q22Howlongdoyoucontinuedualtherapy(i.e.,anoralanticoagulantplusan

antiplateletdrug)inAFpatientsafterprimaryPCIwithstentingforSTEMI?


Total 39

12months,always

1month,ifbare-metal

stentswer...

Indefinitely

0% 20% 40% 60% 80% 100%


12months,always

1month,ifbare-metalstentswereusedand3-6months,ifdrug-elutingstentswereused

Indefinitely


28/31

25,64% 10

69,23% 27

5,13% 2

Q23HowlongdoyoucontinuewithtripletreatmentinyourAFpatientafteraNSTE-

ACS?Répondues:39 Ignorées:8

Total 39

•12months,always

•1month,ifbare-metalstentswer...

•Indefinitely

0% 20% 40% 60% 80% 100%


•12months,always

•1month,ifbare-metalstentswereusedand3-6months,ifdrug-elutingstentswereused

•Indefinitely


29/31

17,95% 7

0% 0

28,21% 11

43,59% 17

10,26% 4

Q24Whendoyoure-initiatepreviouslydiscontinuedNOACtherapyinAFpatients

presentingwithanACSwhounderwentPCIwithstenting?


Total 39

Immediatelywhen

parenteral...

Other

Within24hoursafter

thePCIw i...

>24hoursafterthePCI

withstenting

Other

0% 20% 40% 60% 80% 100%


Immediatelywhenparenteralanticoagulationisstopped

Other

Within24hoursafterthePCIwithstenting

>24hoursafterthePCIwithstenting

Other


30/31

64,10% 25

28,21% 11

7,69% 3

Q25Doyoucontinuewiththesameoralanticoagulantdrugthatpatienthasbeen

takingbeforeACS?Répondues:39 Ignorées:8


Yes

No,Ioftenswitchfroma

NOACtoaVKA

No,Ioftenswitchfroma

VKAtoaN...

0% 20% 40% 60% 80% 100%


Yes

No,IoftenswitchfromaNOACtoaVKA

No,IoftenswitchfromaVKAtoaNOAC(please,tickthepreferredNOAC)


31/31

Q26WhenitcomestodualtreatmentpostACS,whichantiplateletdrugdoyou

preferablycombinewithwarfarin(orotherVKA)oraNOACinyourAFpatient?


88%22

60%15

37

96%24

48%12

36

75%6

37,50%3

9

55,56%5

55,56%5

10

Withwarfarin(orotherVKA) WithaNOAC

Aspirin

Clopidogrel

Prasugrel

Ticagrelor

0% 20% 40% 60% 80% 100%

Withwarfarin(orotherVKA) WithaNOAC Nombretotalderépondants

Aspirin

Clopidogrel

Prasugrel

Ticagrelor

ep wire on european management strategy for acute coronary ... · ep wire on european management...

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