• Behnam Banihashemi, Shaun G Goodman, Raymond T Yan, Robert C Welsh, Shamir R Mehta, Gilles Montalescot, Jan M Kornder, Graham C Wong, Gabor Gyenes, Ph Gabriel Steg, Andrew T Yan, and Global Registry of Acute Coronary Events (GRACE/GRACE(2)) Investigators.
• Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre, Toronto, Ontario, Canada.
• Am. Heart J. 2009 Dec 1; 158 (6): 917-24.

BackgroundThere are limited contemporary data on the early use of clopidogrel or glycoprotein (Gp) IIb/IIIa inhibitors, alone versus combination therapies, in non-ST-elevation acute coronary syndrome (NSTE-ACS).MethodsThis study included 5,806 Canadian NSTE-ACS patients with elevated cardiac biomarker and/or ST deviation on presentation in the prospective GRACE between 2003-2007. We stratified the study population according to the management strategy (non-invasive vs invasive) and into low-(GRACE risk score or=141).ResultsOverall, 3,893 patients (67.1%) received early (ConclusionsIn this contemporary NSTE-ACS population, both clopidogrel and GpIIb/IIIa inhibitors were targeted toward patients treated with an invasive strategy but paradoxically toward the lower-risk group. In particular, clopidogrel appeared to be underused among conservatively managed patients despite its proven efficacy, whereas GpIIb/IIIa inhibitors were administered to only a minority of the high-risk patients with elevated cardiac biomarkers. Our findings emphasize the ongoing need to promote the optimal use of evidence-based antiplatelet therapies among high-risk patients with NSTE-ACS.

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