The current status and outcomes of in-hospital P2Y12 receptor inhibitor switching in Korean patients with acute myocardial infarctionopen access
- 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
- Issue Date
- KOREAN ASSOC INTERNAL MEDICINE
- Myocardial infarction; Platelet aggregation inhibitors; Hemorrhage
- KOREAN JOURNAL OF INTERNAL MEDICINE, v.37, no.2, pp.350 - +
- Journal Title
- KOREAN JOURNAL OF INTERNAL MEDICINE
- Start Page
- End Page
- Background/Aims: 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. 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 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. 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.
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- College of Medicine > Department of Medicine > Journal Articles
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