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;
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
- Death, AMI readmission, and MACE within one year during the follow-up period
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)
- Patient information such as risk behaviors, diet, and physical activities are not available in the NHIRD.
- Hidden bias of medication selection was introduced as the study data was sourced from an administrative database.
- Missing clinical information, such as the severity of AMI at admission, might have induced non-differential misclassification bias.
- Study results might not be generalizable to other populations, as only Taiwanese patients were included in the analysis.
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.