Key Takeaway

A real-word study of Taiwanese patients with AMI undergoing PCI

Showed a comparable 1-year cardiovascular outcome with standard ticagrelor treatment 3 months after the event of AMI

Didn’t report statistically significant differences in:

  • Hazard risk of death
  • AMI admission
  • Major adverse
  • Cardiovascular events (MACE)

Didn’t show a difference in the risk of bleeding, including major or clinically relevant non-major bleeding

Why This Matters

  • Bleeding risks could be reduced P2Y12 inhibitor de-escalation approach is considered by physicians to reduce additional bleeding risks
  • Current studies are not enough Despite recent clinical studies, there’s limited and conflicting evidence on de-escalation strategies. This study aimed to assess the effect of de-escalated P2Y12 inhibitor switching in DAPT on MACE in patients with AMI undergoing PCI;

Study Design

This retrospective and population-based cohort study utilized data from the Taiwan’s National Health Insurance Research Database (NHIRD).

Key inclusion criteria:

  • Patients who were hospitalized with a primary diagnosis of AMI

Key exclusion criteria:

  • Patients aged <18 years, without identification of sex, or Taiwanese citizenship
  • Patients not on heparin or antiplatelet therapy, or were only on aspirin therapy, or
  • received antiplatelet agents other than ticagrelor at index of AMI
  • Patients who had a coronary artery bypass graft
  • Death of the patient within 3 months after the index date of AMI

Key outcomes:

  • Death, AMI readmission, and MACE within one year during the follow-up period

Key Results

Number Of Participants

  • 10,100 patients were included (de-escalated DAPT group: n = 1,901; unchanged DAPT: n = 8,199)

Incidence Rates And Adjusted Hazard Ratio

  • All-cause death (unchanged vs de-escalated DAPT group): Incidence = 2.42 (95% confidence interval [CI]: 2.02–2.90) vs 2.89 (95% CI: 2.05–3.91); adjusted HR = 1.20 (95% CI: 0.83–1.73; P = 0.336)
  • AMI hospitalization (unchanged vs de-escalated DAPT group): Incidence = 3.28 (95% CI: 2.81–3.83) vs 3.68 (95% CI: 2.75–4.88); adjusted HR = 1.12 (95% CI: 0.80–1.56; P = 0.509)
  • MACE (unchanged vs de-escalated DAPT group): Incidence = 4.72 (95% CI: 4.13–5.36) vs 4.91 (95% CI: 3.80–6.26); adjusted HR = 1.04 (95% CI: 0.78–1.39; P = 0.766)
  • Major bleeding (unchanged vs de-escalated DAPT group): Incidence = 2.36 (95% CI: 1.95–2.82) vs 2.12 (95% CI: 1.41–3.01); adjusted HR = 0.92 (95% CI: 0.61–1.37; P = 0.669)

Limitations

  • Only VTE events leading to hospitalisation were included.
  • Lack of data for use of oral contraceptives.
  • Some cases of pulmonary embolism might have been missed because of low autopsy rates in Denmark.
  • Possible misclassification of VTE diagnosis in administrative registries.

    Yeh JS, Hsu CY, Huang CY, Chen WT, Hsieh YC, Chien LN. The effect of de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: A nationwide cohort study. PLoS One. 2021;16(1):e0246029. doi: 10.1371/journal.pone.0246029. PMID: 33493236.

MAT-BH-2200185/v2/Jun 2023