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

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, Jung Han Yoon, Jei Keon Chae, Seung Jae Joo, Dong Joo Choi, Seung Ho HurIn Whan Seong, Myeong Chan Cho, Doo Il Kim, Seok Kyu Oh, Tae Hoon Ahn, Jin Yong Hwang

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims: While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myo- cardial 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 clopi- dogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NA- CEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, com- pared 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 clinicalevents 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.

Original languageEnglish
Pages (from-to)350-365
Number of pages16
JournalKorean Journal of Internal Medicine
Volume37
Issue number2
DOIs
Publication statusPublished - 2022 Mar

Keywords

  • Hemorrhage
  • Myocardial infarction
  • Platelet aggregation inhibitors

ASJC Scopus subject areas

  • Internal Medicine

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