The current status and outcomes of in-hospital P2Y12 receptor inhibitor switching in Korean patients with acute myocardial infarction
- Author:
Keun-Ho PARK
1
;
Myung Ho JEONG
;
Hyun Kuk KIM
;
Young-Jae KI
;
Sung Soo KIM
;
Youngkeun AHN
;
Hyun Yi KOOK
;
Hyo-Soo KIM
;
Hyeon Cheol GWON
;
Ki Bae SEUNG
;
Seung Woon RHA
;
Shung Chull CHAE
;
Chong Jin KIM
;
Kwang Soo CHA
;
Jong Seon PARK
;
Jung Han YOON
;
Jei Keon CHAE
;
Seung Jae JOO
;
Dong-Joo CHOI
;
Seung Ho HUR
;
In Whan SEONG
;
Myeong Chan CHO
;
Doo Il KIM
;
Seok Kyu OH
;
Tae Hoon AHN
;
Jin Yong HWANG
;
Author Information
- Publication Type:2
- From:The Korean Journal of Internal Medicine 2022;37(2):350-365
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myocardial infarction (AMI) patients, the current status of in-hospital P2Y12RI switching remains unknown.
Methods:Overall, 8,476 AMI patients who underwent successful revascularization from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were divided according to in-hospital P2Y12RI strategies, and net adverse cardiovascular events (NACEs), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), stroke, or thrombolysis in myocardial infarction (TIMI) major bleeding during hospitalization were compared.
Results:Patients with in-hospital P2Y12RI switching accounted for 16.5%, of which 867 patients were switched from clopidogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NACEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, compared to the unchanged clopidogrel group, the C-P group had a higher incidence of non-fatal MI, and the P-C group had a higher incidence of TIMI major bleeding. In clinical events of in-hospital P2Y12RI switching, 90.9% of non-fatal MI occurred during pre-switching clopidogrel administration, 60.7% of TIMI major bleeding was related to pre-switching P2Y12RIs, and 71.4% of TIMI major bleeding was related to potent P2Y12RIs. Only 21.6% of the P2Y12RI switching group switched to P2Y12RIs after a loading dose (LD); however, there were no differences in clinical events between patients with and without LD.
Conclusions:In-hospital P2Y12RI switching occurred occasionally, but had relatively similar clinical outcomes compared to unchanged P2Y12RIs in Korean AMI patients. Non-fatal MI and bleeding appeared to be mainly related to pre-switching P2Y12RIs.
