The Korean Journal of Internal Medicine (Mar 2022)

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 Hur,
  • In Whan Seong,
  • Myeong Chan Cho,
  • Doo Il Kim,
  • Seok Kyu Oh,
  • Tae Hoon Ahn,
  • Jin Yong Hwang,
  • on behalf of the KAMIR-NIH registry investigators

DOI
https://doi.org/10.3904/kjim.2021.101
Journal volume & issue
Vol. 37, no. 2
pp. 350 – 365

Abstract

Read online

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.

Keywords