Predictors of In-Hospital De-Escalation of P2Y12 Inhibitors to Clopidogrel in Patients With Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention.

Autor: Williams MU; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA. Electronic address: mikeuwilliams@hotmail.com., Lang WR; Department of Internal Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Wark T; Department of Internal Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Ovide G; Department of Internal Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Mitsuyama R; Department of Internal Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Kadiyala V; Department of Internal Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Long S; Department of Internal Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Heinl RE; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Kah MO; Department of Biology, Towson University, Towson, MD, USA., Sharma E; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Hyder ON; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Bavishi C; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Kennedy KF; Department of Cardiology, St Luke's Hospital, Kansas City, KS, USA., Aronow H; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA., Abbott JD; Department of Cardiovascular Medicine, Warren Alpert Medical School of Brown University/Lifespan Health System, Providence, RI, USA.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2022 Sep; Vol. 42, pp. 154-158. Date of Electronic Publication: 2022 Feb 03.
DOI: 10.1016/j.carrev.2022.01.029
Abstrakt: Background: Ticagrelor or prasugrel are recommended to reduce ischemic events in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). However, in clinical practice, patients are often switched from a potent P2Y12 inhibitor to clopidogrel prior to or at discharge ('de-escalation'). We sought to assess the incidence and predictors of de-escalation.
Methods: Consecutive patients who received either a ticagrelor or prasugrel loading dose for AMI PCI at two tertiary centers between Jan 2015-Mar 2019 who survived to discharge were included. Data were obtained from the electronic health record and institutional NCDR CathPCI data. Patients who were de-escalated to clopidogrel were compared with those who remained on potent P2Y12 inhibitors through the time of discharge.
Results: Of the1818 patients in the cohort, 1146 (63%) were de-escalated. Patients in the de-escalation group were older, more often Black, had lower prevalence of co-morbidities, less often had private insurance, and had less complex PCI. After adjustment, older age remained positively associated (OR 1.2, CI 1.08-1.34, p = .001) and Caucasian race (OR 0.5, CI 0.33-0.77, p = .002), prior MI (OR 0.7, CI 0.5-0.97, p = .032), bifurcation lesion (OR 0.71, CI 0.53-0.95, p = .019), and greater number of stents (OR 0.82, CI 0.75-0.91, p = .0001) were negatively associated with de-escalation. In de-escalated patients, the rationale was not documented in 75.9% of cases.
Conclusions: De-escalation occurred frequently in patients with AMI and was associated with both non-clinical and clinical factors. Medical decision making was poorly documented and represent an area for improvement.
Competing Interests: Declaration of competing interest None.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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