The current status and outcomes of in-hospital P2Y12 receptor inhibitor switching in Korean patients with acute myocardial infarction

Autor: Keun-Ho Park, 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, on behalf of the KAMIR-NIH registry investigators
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: The Korean Journal of Internal Medicine, Vol 37, Iss 2, Pp 350-365 (2022)
Druh dokumentu: article
ISSN: 1226-3303
2005-6648
DOI: 10.3904/kjim.2021.101
Popis: 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.
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