Abstract 21117: Comparison of Clinical Outcomes Between Clopidogrel and New P2Y12 Antagonist in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

Abstract

Background: Recent studies have suggested new P2Y12 antagonists (prasugrel /ticagrelor) are more effective in high thrombotic conditions than conventional clopidogrel The aim of this study was to compare the clinical outcomes between clopidogrel abd new P2Y12 antagonist in acute myocardial infarction patients treated with percutaneous coronary intervention (PCI). Methods: Between November 2011 and January 2016, a total of 11,731 AMI patients treated with PCI (7580 patients were prescribed clopidogrel and 4151 patients new P2Y12 antagonists) were enrolled in the Korean Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) database. Propensity score matching was performed to adjust for differences in baseline clinical variables. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial infarction, target-lesion revascularization (TLR), and stroke. Results: After propensity matching (4151 pairs), the rate of MACCEs were more frequently occurred in the clopidogrel group than in the new P2Y12 (8.2% vs. 6.4%, p=0.002). The difference in MACCE between two groups was driven by cardiac death (4.7% vs. 3.3%, p<0.001). There was no significant difference in myocardial infarction (0.7% vs. 0.6%, p=0.783), TLR (2.4% vs. 1.8%, p=0.337), and stroke (0.8% vs. 0.7%, p=0.336). However, the incidences of Thrombolysis In Myocardial Infarction (TIMI) minor bleeding showed a trend toward a lower incidence in the clopidogrel group (13.8% vs. 17.3%, p=0.057). Conclusion: Our study shows that new P2Y12 antagonist was associated lower rate of MACCE and cardiac mortality in AMI patients treated with PCI.