Post on 14-Dec-2018
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
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
2/31
Q2YouremailAddressis:Répondues:45 Ignorées:2
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
3/31
95,74% 45
4,26% 2
Q3WouldyoubecomfortableifweacknowledgeyourcentreintheEuropace
JournalandontheWebsiteRépondues:47 Ignorées:0
Total 47
Yes
No
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Yes
No
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
4/31
80,85% 38
19,15% 9
Q4Doyouhavecardiacsurgeryatyourinstitution
Répondues:47 Ignorées:0
Total 47
Yes
No
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Yes
No
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
None
1-99
100-199
200-399
400ormore
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
None
1-99
100-199
200-399
400ormore
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
None
1-99
100-199
200-399
400ormore
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
8/31
4,65% 2
6,98% 3
6,98% 3
23,26% 10
58,14% 25
Q8Numberofinvasivecoronaryinterventionprocedures
(angioplasty/stenting)peryearinyourinstitutionaverages:
Répondues:43 Ignorées:4
Total 43
None
Upto100
101–500
501–1000
>1000
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
None
Upto100
101–500
501–1000
>1000
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
None
≤50patients
51-100patients
>100patients
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
10/31
Q10WhatisthepreferredstrategyinyourcentreforAFpatientspresentingwithSTEMIwithinanoptimaltimeframefor
intervention,whoarealreadytakingwarfarinoraNOAC?
Répondues:43 Ignorées:4
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
11/31
ForAFpatientstakingaVitaminKantagonist(VKA)
PrimaryPCIwithuninterruptedwarfarinregardlessoftheINRvalue
PrimaryPCIwithuninterruptedwarfarinonlyiftheINRisbelow(please,statethecut-offvalue)
Fibrinolytic therapy Conservativetreatment
Oneanswerpersection
0% 20% 40% 60% 80% 100%
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
Noadditionalantithrombotic medication
Aspirin
Clopidogrel
PrasugrelorTicagrelor
Heparin(unfractionatedorLMWH)
GPIIb/IIIainhibitors
Idonotpersonallyperforminvasivecoronaryprocedures(angioplasty/stenting)andcannotanswerthisquestion
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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
Nombretotalderépondants:43
Noadditional
antithromb...
Aspirin
Clopidogrel
PrasugrelorTicagrelor
Heparin(unfractionatedorLMWH)
GPIIb/IIIainhibitors
Idonotpersonallyperform...
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Noadditionalantithrombotic medication
Aspirin
Clopidogrel
PrasugrelorTicagrelor
Heparin(unfractionatedorLMWH)
GPIIb/IIIainhibitors
Idonotpersonallyperforminvasivecoronaryprocedures(angioplasty/stenting)andcannotanswerthisquestion
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
Yes,always
Yes,aVKA
Yes,aNOAC
No
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
17/31
Q14HowdoyoucommonlyestimatetherisksofAF-relatedthromboembolic
events,ischemiceventsandbleedinginAFpatientspresentingwithaNSTE-ACS?
Répondues:39 Ignorées:8
Usingcommon
clinicalsense
TheGRACEscore
TheTIMIscore
TheCRUSADE
score
TheACUITY/HORIZONSderiv ed...
TheCHADS2score
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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)
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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
Nombretotalderépondants:39
Noadditional
antithromb...
Aspirin
Clopidogrel
PrasugrelorTicagrelor
Heparin(unfractionatedorLMWH)
GPIIb/IIIainhibitors
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Noadditionalantithrombotic medication
Aspirin
Clopidogrel
PrasugrelorTicagrelor
Heparin(unfractionatedorLMWH)
GPIIb/IIIainhibitors
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
20/31
17,95% 7
38,46% 15
43,59% 17
Q16Whichaccessroute(puncturesite)isusedatyourcentreinAFpatientsona
VKA/NOAC,undergoingcoronaryangiographyoraPCIwithstenting?
Répondues:39 Ignorées:8
Total 39
Femoral
Radial,always
Radial,iftheoperator
hasadequa...
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Femoral
Radial,always
Radial,i ftheoperatorhasadequateexperience
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
OtherStent(seebelow)
Drug-elutingstents
Drug-elutingstents,iftheriskofbleedingwithsubsequenttripletherapyisnottoohigh
Bare-metalstents
Otherstents(please,statewhichone)
Wedonothaveaspecific strategyforthesepatients
Other(Seebelow)
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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
Nombretotalderépondants:39
Inv asiv estrategies
(coronary...
Bare-metalstentsare
preferred...
Soleballoonangioplastyinsteadof...
Bypasssurgery
insteadof...
Nospecificmeasure
taken
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Invasivestrategies(coronaryangiographyandrevascularization)shouldbedelayedaslongaspossibleinsuchpatients
Bare-metalstentsarepreferredabovedrug-elutingstentstoshortenexposuretodualortripletherapy
SoleballoonangioplastyinsteadofstentimplantationshouldbeconsideredinAFpatientsathighbleedingriskrequiringtripletherapy
BypasssurgeryinsteadofPCIstentingshouldbeconsideredinAFpatientsathighbleedingriskwithtripletherapy
Nospecific measuretaken
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
Yes
No,IusetripletherapyonlyinAFpatientsatmoderate-to-highriskofthromboembolic eventsregardlessofthebleedingrisk.
No,IusetripletherapyonlyinAFpatientsatmoderate-to-highriskofthromboembolic eventsiftheriskofbleedingisnottoohigh
No,IusetripletherapyonlyinAFpatientswithdrug-elutingstentsatmoderate-to-highriskofthromboembolic eventsiftheriskofbleedingisnottoohigh.
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
24/31
Q20Whichcombination(s)offollowingdrugsdoyoupreferablyusefortriple
therapyinyourAFpatientsafteranACS?(please,tickalloptionsyouwouldchoose)
Répondues:39 Ignorées:8
Warfarin(orotherVKA)withtheI...
Warfarin(orotherVKA)withtheI...
Dabigatran150mgbid
Dabigatran110mgbid
Riv aroxaban20mgonce
daily
Riv aroxaban15mgonce
daily
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
9-12months,regardlessofthebleedingrisk
Atleast1monthforbare-metalstentsandatleast3-6monthsfordrug-elutingstents(dependingonthestenttype),particularlyiftheriskofbleedingishigh
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
27/31
58,97% 23
25,64% 10
15,38% 6
Q22Howlongdoyoucontinuedualtherapy(i.e.,anoralanticoagulantplusan
antiplateletdrug)inAFpatientsafterprimaryPCIwithstentingforSTEMI?
Répondues:39 Ignorées:8
Total 39
12months,always
1month,ifbare-metal
stentswer...
Indefinitely
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
12months,always
1month,ifbare-metalstentswereusedand3-6months,ifdrug-elutingstentswereused
Indefinitely
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
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%
Choixderéponses Réponses
•12months,always
•1month,ifbare-metalstentswereusedand3-6months,ifdrug-elutingstentswereused
•Indefinitely
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
29/31
17,95% 7
0% 0
28,21% 11
43,59% 17
10,26% 4
Q24Whendoyoure-initiatepreviouslydiscontinuedNOACtherapyinAFpatients
presentingwithanACSwhounderwentPCIwithstenting?
Répondues:39 Ignorées:8
Total 39
Immediatelywhen
parenteral...
Other
Within24hoursafter
thePCIw i...
>24hoursafterthePCI
withstenting
Other
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Immediatelywhenparenteralanticoagulationisstopped
Other
Within24hoursafterthePCIwithstenting
>24hoursafterthePCIwithstenting
Other
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
30/31
64,10% 25
28,21% 11
7,69% 3
Q25Doyoucontinuewiththesameoralanticoagulantdrugthatpatienthasbeen
takingbeforeACS?Répondues:39 Ignorées:8
Nombretotalderépondants:39
Yes
No,Ioftenswitchfroma
NOACtoaVKA
No,Ioftenswitchfroma
VKAtoaN...
0% 20% 40% 60% 80% 100%
Choixderéponses Réponses
Yes
No,IoftenswitchfromaNOACtoaVKA
No,IoftenswitchfromaVKAtoaNOAC(please,tickthepreferredNOAC)
EPWIREonEuropeanManagementStrategyforAcuteCoronarySyndromes(ACS)in
31/31
Q26WhenitcomestodualtreatmentpostACS,whichantiplateletdrugdoyou
preferablycombinewithwarfarin(orotherVKA)oraNOACinyourAFpatient?
Répondues:39 Ignorées:8
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