Abstract 12825: One-Year Outcome Following Acute Phase Switching Among P2y12 Inhibitors; Results From the Real-World Database of Japan Ami Registry (JAMIR)

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A12825-A12825
• Main Authors: Honda, Satoshi, Takegami, Misa, Kensaku, Nishihira, Kojima, Sunao, Asaumi, Yasuhide, Suzuki, Makoto, Kosuge, Masami, Takahashi, Jun, Sakata, Yasuhiko, Takayama, Morimasa, Sumiyoshi, Tetsuya, Ogawa, Hisao, Kimura, Kazuo, Yasuda, Satoshi
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.12825

BackgroundIntroduction of new potent P2Y12 inhibitors such as prasugrel has enabled physicians to contemplate switching among therapies due to specific clinical scenarios. We aimed to examine outcomes of patients with acute myocardial infarction (AMI) who underwent switching of P2Y12 inhibitors in real-world clinical practice.Methods and ResultsThe Japan AMI Registry (JAMIR) prospectively enrolled 3411 AMI patients from 50 institutes between December 2015 and May 2017. After exclusion of patients without information of antiplatelet therapy and those with triple antiplatelet therapy, 3194 patients were enrolled. Among them, 125 patients (4%) underwent switching between prasugrel and clopidogrel at median 6.5 days after the onset, among whom 115 patients (92%) were initially treated with prasugrel, then switched to clopidogrel. The remaining patients were treated with either prasugrel (n=2607) or clopidogrel (n= 462) without switching of P2Y12 inhibitors. Patients in the switching group were younger, less likely to be female, and more likely to show STEMI compared to those in the clopidogrel group, while characterized by more comorbidities such as cerebrovascular disease and atrial fibrillation compared to those in the prasugrel group. The incidence of ischemic events (composite of cardiovascular death, MI and stroke) in the switching group (4.8%) was comparable with that in the prasugrel group (6.8%), but significantly lower than that in the clopidogrel group (10.0%) (p=0.03). Incidence of BARC type 3 or 5 bleeding in the switching group (16.0%) was significantly higher than in either the prasugrel (3.8%) or clopidogrel group (7.8%) (p