Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction

on behalf of the KAMIR-NIH Registry Investigators

Research output: Contribution to journalArticle

Abstract

Background: Potent P2Y12 blockers are preferred in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). However, the risk of bleeding remains a major concern. We assessed the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 4927 patients with NSTEMI receiving drug-eluting stents (DES) were divided into potent P2Y12 blocker (ticagrelor or prasugrel, n = 901) and clopidogrel (n = 3180) groups. Propensity-matched 12-month ischemic and bleeding events were compared. Patients who received anticoagulants or who discontinued P2Y12 blockers or switched between potent P2Y12 blockers and clopidogrel were excluded. Results: In the overall population, patients at higher ischemic and bleeding risks more often received clopidogrel. After propensity matching (n = 901 in each group), 12-month rates of major adverse cardiac and cerebrovascular events were lower (7.3% vs. 10.1%, p = 0.038), but Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were higher (5.9% vs. 2.2%, p < 0.001) with potent P2Y12 blockers. Twelve-month rates of death from any cause, MI, stroke, or TIMI major bleeding were not different. On multivariate analysis, 12-month risk of TIMI major or minor bleeding was higher with B2 or C lesion, potent P2Y12 blocker use, body weight <60 kg, and lower with time to PCI <12 h and radial artery access. Conclusions: In patients with NSTEMI receiving DES, potent P2Y12 blockers were associated with reduced ischemic but increased bleeding risk with similar net clinical benefits.

Original languageEnglish
Pages (from-to)142-150
Number of pages9
JournalJournal of Cardiology
Volume73
Issue number2
DOIs
Publication statusPublished - 2019 Feb 1

Fingerprint

clopidogrel
Hemorrhage
Myocardial Infarction
Drug-Eluting Stents
Percutaneous Coronary Intervention
Radial Artery
Non-ST Elevated Myocardial Infarction
National Institutes of Health (U.S.)
Korea
Anticoagulants
Registries
Cause of Death
Multivariate Analysis
Stroke
Body Weight
Databases
Mortality
Population

Keywords

  • Antiplatelet agents
  • Drug-eluting stents
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction. / on behalf of the KAMIR-NIH Registry Investigators.

In: Journal of Cardiology, Vol. 73, No. 2, 01.02.2019, p. 142-150.

Research output: Contribution to journalArticle

on behalf of the KAMIR-NIH Registry Investigators. / Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction. In: Journal of Cardiology. 2019 ; Vol. 73, No. 2. pp. 142-150.
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abstract = "Background: Potent P2Y12 blockers are preferred in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). However, the risk of bleeding remains a major concern. We assessed the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 4927 patients with NSTEMI receiving drug-eluting stents (DES) were divided into potent P2Y12 blocker (ticagrelor or prasugrel, n = 901) and clopidogrel (n = 3180) groups. Propensity-matched 12-month ischemic and bleeding events were compared. Patients who received anticoagulants or who discontinued P2Y12 blockers or switched between potent P2Y12 blockers and clopidogrel were excluded. Results: In the overall population, patients at higher ischemic and bleeding risks more often received clopidogrel. After propensity matching (n = 901 in each group), 12-month rates of major adverse cardiac and cerebrovascular events were lower (7.3{\%} vs. 10.1{\%}, p = 0.038), but Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were higher (5.9{\%} vs. 2.2{\%}, p < 0.001) with potent P2Y12 blockers. Twelve-month rates of death from any cause, MI, stroke, or TIMI major bleeding were not different. On multivariate analysis, 12-month risk of TIMI major or minor bleeding was higher with B2 or C lesion, potent P2Y12 blocker use, body weight <60 kg, and lower with time to PCI <12 h and radial artery access. Conclusions: In patients with NSTEMI receiving DES, potent P2Y12 blockers were associated with reduced ischemic but increased bleeding risk with similar net clinical benefits.",
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T1 - Association of potent P2Y12 blockers with ischemic and bleeding outcomes in non-ST-segment elevation myocardial infarction

AU - on behalf of the KAMIR-NIH Registry Investigators

AU - Sim, Doo Sun

AU - Jeong, Myung Ho

AU - Kim, Hyo Soo

AU - Gwon, Hyeon Cheol

AU - Seung, Ki Bae

AU - Rha, Seung-Woon

AU - Chae, Shung Chull

AU - Kim, Chong Jin

AU - Cha, Kwang Soo

AU - Park, Jong Sun

AU - Yoon, Jung Han

AU - Chae, Jei Keon

AU - Joo, Seung Jae

AU - Choi, Dong Ju

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Cho, Myeong Chan

AU - Kim, Doo Il

AU - Oh, Seok Kyu

AU - Ahn, Tae Hoon

AU - Hwang, Jin Yong

PY - 2019/2/1

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N2 - Background: Potent P2Y12 blockers are preferred in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). However, the risk of bleeding remains a major concern. We assessed the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 4927 patients with NSTEMI receiving drug-eluting stents (DES) were divided into potent P2Y12 blocker (ticagrelor or prasugrel, n = 901) and clopidogrel (n = 3180) groups. Propensity-matched 12-month ischemic and bleeding events were compared. Patients who received anticoagulants or who discontinued P2Y12 blockers or switched between potent P2Y12 blockers and clopidogrel were excluded. Results: In the overall population, patients at higher ischemic and bleeding risks more often received clopidogrel. After propensity matching (n = 901 in each group), 12-month rates of major adverse cardiac and cerebrovascular events were lower (7.3% vs. 10.1%, p = 0.038), but Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were higher (5.9% vs. 2.2%, p < 0.001) with potent P2Y12 blockers. Twelve-month rates of death from any cause, MI, stroke, or TIMI major bleeding were not different. On multivariate analysis, 12-month risk of TIMI major or minor bleeding was higher with B2 or C lesion, potent P2Y12 blocker use, body weight <60 kg, and lower with time to PCI <12 h and radial artery access. Conclusions: In patients with NSTEMI receiving DES, potent P2Y12 blockers were associated with reduced ischemic but increased bleeding risk with similar net clinical benefits.

AB - Background: Potent P2Y12 blockers are preferred in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). However, the risk of bleeding remains a major concern. We assessed the association of potent P2Y12 blockers with ischemic and bleeding outcomes in patients with NSTEMI. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 4927 patients with NSTEMI receiving drug-eluting stents (DES) were divided into potent P2Y12 blocker (ticagrelor or prasugrel, n = 901) and clopidogrel (n = 3180) groups. Propensity-matched 12-month ischemic and bleeding events were compared. Patients who received anticoagulants or who discontinued P2Y12 blockers or switched between potent P2Y12 blockers and clopidogrel were excluded. Results: In the overall population, patients at higher ischemic and bleeding risks more often received clopidogrel. After propensity matching (n = 901 in each group), 12-month rates of major adverse cardiac and cerebrovascular events were lower (7.3% vs. 10.1%, p = 0.038), but Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding rates were higher (5.9% vs. 2.2%, p < 0.001) with potent P2Y12 blockers. Twelve-month rates of death from any cause, MI, stroke, or TIMI major bleeding were not different. On multivariate analysis, 12-month risk of TIMI major or minor bleeding was higher with B2 or C lesion, potent P2Y12 blocker use, body weight <60 kg, and lower with time to PCI <12 h and radial artery access. Conclusions: In patients with NSTEMI receiving DES, potent P2Y12 blockers were associated with reduced ischemic but increased bleeding risk with similar net clinical benefits.

KW - Antiplatelet agents

KW - Drug-eluting stents

KW - Myocardial infarction

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