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

• Published in: The Korean journal of internal medicine 2022, 37(2), , pp.350-365
• Main Authors: Park, Keun-Ho, Jeong, Myung Ho, Kim, Hyun Kuk, Ki, Young-Jae, Kim, Sung Soo, Ahn, Youngkeun, Kook, Hyun Yi, Kim, Hyo-Soo, Gwon, Hyeon Cheol, Seung, Ki Bae, Rha, Seung Woon, Chae, Shung Chull, Kim, Chong Jin, Cha, Kwang Soo, Park, Jong Seon, Yoon, Jung Han, Chae, Jei Keon, Joo, Seung Jae, Choi, Dong-Joo, Hur, Seung Ho, Seong, In Whan, Cho, Myeong Chan, Kim, Doo Il, Oh, Seok Kyu, Ahn, Tae Hoon, Hwang, Jin Yong
• Format: Article
• Language: English
• Subjects: Clopidogrel - adverse effects; hemorrhage; Hemorrhage - chemically induced; Hospitals; Humans; myocardial infarction; Myocardial Infarction - drug therapy; Original; Percutaneous Coronary Intervention - adverse effects; platelet aggregation inhibitors; Platelet Aggregation Inhibitors - adverse effects; Prasugrel Hydrochloride - adverse effects; Purinergic P2Y Receptor Antagonists - adverse effects; Treatment Outcome; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2021.101

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. 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. 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. 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.