Korean J Intern Med.  2022 Mar;37(2):350-365. 10.3904/kjim.2021.101.

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

• Park KH
• Jeong MH
• Kim HK
• Ki YJ
• Kim SS
• Ahn Y
• Kook HY
• Kim HS
• Gwon HC
• Seung KB
• Rha SW
• Chae SC
• Kim CJ
• Cha KS
• Park JS
• Yoon JH
• Chae JK
• Joo SJ
• Choi DJ
• Hur SH
• Seong IW
• Cho MC
• Kim DI
• Oh SK
• Ahn TH
• Hwang JY
• on behalf of the KAMIR-NIH registry investigators

• KMID: 2527299
• DOI: http://doi.org/10.3904/kjim.2021.101

Abstract

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.

Keyword

Myocardial infarction; Platelet aggregation inhibitors; Hemorrhage