The current status and outcomes of in-hospital P2Y12 receptor inhibitor switching in Korean patients with acute myocardial infarction
- Authors
- 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; Junghan 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
- Issue Date
- Mar-2022
- Publisher
- 대한내과학회
- Keywords
- Myocardial infarction; Platelet aggregation inhibitors; Hemorrhage
- Citation
- The Korean Journal of Internal Medicine, v.37, no.2, pp.350 - 365
- Journal Title
- The Korean Journal of Internal Medicine
- Volume
- 37
- Number
- 2
- Start Page
- 350
- End Page
- 365
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/83594
- DOI
- 10.3904/kjim.2021.101
- ISSN
- 1226-3303
- 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.
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