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, Doo Sun Sim, Myung Ho Jeong, Hyo Soo Kim, Hyeon Cheol Gwon, Ki Bae Seung, Seung-Woon Rha, Shung Chull Chae, Chong Jin Kim, Kwang Soo Cha, Jong Sun Park, Jung Han Yoon, Jei Keon Chae, Seung Jae Joo, Dong Ju Choi, Seung Ho Hur, In Whan Seong, Myeong Chan Cho, Doo Il Kim, Seok Kyu Oh & 2 others Tae Hoon Ahn, Jin Yong Hwang

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.

LanguageEnglish
Pages142-150
Number of pages9
JournalJournal of Cardiology
Volume73
Issue number2
DOIs
Publication statusPublished - 2019 Feb 1

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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

Y1 - 2019/2/1

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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