Abstract
To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Patients who had received PCI during hospitalization for AMI (between 2013 and 2016) and were initially treated with aspirin and ticagrelor and without adverse events after 3 months of treatment were retrospectively evaluated. In total, 1,901 and 8,199 patients were identified as "de-escalated DAPT" (switched to aspirin and clopidogrel) and "unchanged DAPT" (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68, and 4.91 in the de-escalated cohort and 2.42, 3.28, and 4.72 in the unchanged cohort, respectively, based on an inverse probability of treatment weighted approach that adjusting for baseline characteristics of the patients. Multivariate Cox regression analyses showed the two groups had no significant differences in the hazard risk of death, AMI admission, and MACE. Additionally, there was no observed difference in the risk of bleeding, including major or clinically relevant non-major bleeding. The real-world data revealed that de-escalation of P2Y12 inhibitor in DAPT was not associated with a higher risk of death or AMI readmission in Taiwanese patients with AMI undergoing successful PCI.
Highlights
Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel has been recommended for greater than 10 years as the gold standard for antithrombotic therapy for patients with acute coronary syndrome (ACS)
standardized mean differences (SMD) is the most commonly used statistic to examine the balance of covariate distribution between treatment groups in the propensity score analysis
Oral P2Y12 receptor inhibitors are critical for secondary prevention of thrombotic events in ACS patients, for those treated with percutaneous coronary intervention (PCI)
Summary
Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel has been recommended for greater than 10 years as the gold standard for antithrombotic therapy for patients with acute coronary syndrome (ACS). The P2Y12 inhibitor de-escalation strategy is already considered and used by many physicians when treating patients with ACS in order to reduce further bleeding risks [5] Both unguided (platelet function testing independent) and guided (platelet function testing dependent or CYP2C19 genotype guided) P2Y12 inhibitor de-escalation strategies have been investigated in several clinical studies, the data remain limited and conflicting [6,7,8]. The objective of this study was to examine the effect of de-escalated P2Y12 inhibitor switching in DAPT on the major cardiovascular risks in patients with acute myocardial infarction (AMI) undergoing PCI based on real-world data from the Taiwan’s National Health Insurance Research Database (NHIRD)
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