Initiation of and persistence with P2Y12 inhibitors in patients with myocardial infarction according to revascularization strategy: a nationwide study.

Abstract

BACKGROUND:

We aimed to analyse initiation of and persistence with P2Y12 inhibitors after first-time myocardial infarction (MI).

METHODS AND RESULTS:

Using Danish nationwide registries, we identified patients ≥30 years with first-time MI during 1 January 2005-30 June 2016 and subsequent prescriptions of P2Y12 inhibitors. Independent factors related to initiation of and persistence with P2Y12 inhibitors were analysed by multivariable logistic regression and a Cox proportional hazards model. Patients were stratified by revascularization strategy: percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical therapy alone (MTA). Overall, 79 597 MI patients were included with 39 172 undergoing PCI, 2619 CABG, and 16 640 MTA, showing initiation of P2Y12 inhibitors of 93.4%, 49.0%, and 51.5%, respectively. Congestive heart failure, cerebrovascular disease, cardiac dysrhythmias, renal failure, previous bleeding, and oral anticoagulants were associated with less initiation of P2Y12 inhibitors. Female sex was associated with less initiation of P2Y12 inhibitors following MTA. MTA, coronary angiography, cerebrovascular disease, diabetes with complications, previous bleeding, antidiabetics, and ticagrelor as P2Y12 inhibitor were associated with non-persistence, whereas female sex, advanced age, and concomitant pharmacotherapy with angiotensin-converting enzyme inhibitors, beta-blockers, statins, oral anticoagulants, and aspirin were associated with high persistence.

CONCLUSION:

Initiation of P2Y12 inhibitors in PCI-treated MI patients was high in contrast to those treated with CABG or MTA and patients with certain comorbidities. Further studies on the benefit-risk ratio of P2Y12 inhibitors in CABG-treated or MTA-treated patients and patients with comorbidities after first-time MI are warranted, as is focus on persistence among patients receiving MTA, patients with comorbidities, and users of ticagrelor.

• Authors: Daniel H Tajchman, Hafsah Nabi, Mohsin Aslam, Jawad H Butt, Erik L Grove, Thomas Engstrøm, Lene Holmvang, Emil L Fosbøl, Lars Køber, Rikke Sørensen
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 10 Issue 7 Pg. 774-786 (Oct 01 2021) ISSN: 2048-8734 [Electronic] England
• PMID: 34570197 (Publication Type: Journal Article)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Clopidogrel
• Prasugrel Hydrochloride

Topics

• Clopidogrel
• Female
• Humans
• Middle Aged
• Myocardial Infarction (drug therapy, epidemiology)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (therapeutic use)
• Prasugrel Hydrochloride
• Purinergic P2Y Receptor Antagonists (therapeutic use)
• Treatment Outcome