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Original research article
Switching between thienopyridines in patients with acute myocardial infarction and quality of care
  1. Francois Schiele1,
  2. Etienne Puymirat2,
  3. Laurent Bonello3,
  4. Nicolas Meneveau1,
  5. Jean-Philippe Collet4,
  6. Pascal Motreff5,6,
  7. Ramin Ravan7,
  8. Florence Leclercq8,
  9. Pierre-Vladimir Ennezat9,
  10. Jean Ferrières10,
  11. Tabassome Simon11 and
  12. Nicolas Danchin12
  1. 1Department of Cardiology, University Hospital Jean Minjoz, Besancon, France
  2. 2Department of Cardiology, European Hospital of Georges Pompidou, Paris, France
  3. 3Département de Cardiologie, Centre Hospitalo-Universitaire Nord, Marseille, France
  4. 4Institut de Cardiologie (APHP), INSERM CMR937 and Univ Paris 6, Pitié-Salpêtrière University Hospital, Paris, France
  5. 5Department of Cardiology, Gabriel Montpied Hospital, Clermont-Ferrand, France
  6. 6University of Auvergne, ERIM-EA3295, Clermont-Ferrand, France
  7. 7Centre Hospitalier Général, Vichy, France
  8. 8Department of Cardiologie, Chu Montpellier, Montpellier, France
  9. 9Service de Cardiologie, Clinique mutualiste des Eaux Claires, Grenoble, France
  10. 10Department of Cardiology, University Hospital Rangueil, Toulouse, France
  11. 11Université Pierre et Marie Curie – Paris 6, Paris, France
  12. 12Department of Cardiology, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France
  1. Correspondence to Professor Francois Schiele; francois.schiele{at}


Objective In acute coronary syndromes, switching between thienopyridines is frequent. The aims of the study were to assess the association between switching practices and quality of care.

Methods Registry study performed in 213 French public university, public non-academic and private hospitals. All consecutive patients admitted for acute myocardial infarction (MI; <48 hours) between 1/10/2010 and 30/11/2010 were eligible. Clinical and biological data were recorded up to 12 months follow-up.

Results Among 4101 patients receiving thienopyridines, a switch was performed in 868 (21.2%): 678 (16.5%) from clopidogrel to prasugrel and 190 (4.6%) from prasugrel to clopidogrel. Predictors of switch were ST segment elevation MI presentation, admission to a cardiology unit, previous percutaneous coronary intervention, younger age, body weight >60 kg, no history of stroke, cardiac arrest, anaemia or renal dysfunction. In patients with a switch, eligibility for prasugrel was >82% and appropriate use of a switch was 86% from clopidogrel to prasugrel and 20% from prasugrel to clopidogrel. Quality indicators scored higher in the group with a switch and also in centres where the switch rate was higher.

Conclusions As applied in the French Registry on Acute ST-elevation and non ST-elevation Myocardial Infarction (FAST-MI) registry, switching from one P2Y12 inhibitor to another led to a more appropriate prescription and was associated with higher scores on indicators of quality of care.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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