From 2011-2023 in the ProACS registry, clopidogrel use after ACS PCI decreased as ticagrelor use rose post-2015 to become the predominant P2Y12 inhibitor.
In a Portuguese registry of ACS patients undergoing PCI, there was a progressive shift from clopidogrel to ticagrelor as the preferred P2Y12 inhibitor post-2015, reflecting updated clinical guidelines.
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Abstract Background The choice of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) is crucial. This study examines trends in P2Y12 inhibitor prescription from 2011 to 2023, focusing on shifts in utilization across different patient demographics and clinical presentations. Methods Patients with a diagnosis of acute coronary syndrome upon hospital admission who were enrolled in the ProACS registry between January 2011 and December 2023 were included if they underwent PCI and received DAPT with aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor or prasugrel) during the index hospitalization. Patients treated conservatively, referred for surgical revascularization, or with missing data concerning the therapeutic strategy were excluded. P2Y12 prescription patterns were stratified by age, sex, clinical diagnosis, and in-hospital outcomes. Changes in prescription patterns over time were assessed using p-trend analysis. Results Among 12 147 patients (24.3% female), clopidogrel was the most commonly prescribed P2Y12 inhibitor (67%), followed by ticagrelor (32%) and prasugrel (1%). Significant changes in prescription patterns were observed: clopidogrel use decreased progressively, with ticagrelor becoming the preferred agent post-2015, although a downtrend was noted after 2021. Prasugrel use remained low but increased slightly in 2022-2023. Clopidogrel use was more common in older patients (median age 65.7 IQR 55.7-75.7 years) with comorbidities such as diabetes and hypertension. In comparison, ticagrelor and prasugrel were predominantly used in younger patients (median age 62.8 IQR 53.9-71.5 years and 57.3 IQR 52.1-64.7 years, respectively) and those presenting with ST-elevation myocardial infarction. Clopidogrel showed a relative increase in prescription rates among female patients after ACS from 2017 onwards, with women making up a maximum of 35% of patients prescribed clopidogrel in 2019 (p-value for trend 0.001). When stratified by sex, no significant differences were observed in prescription trends for ticagrelor, prasugrel, or overall P2Y12 inhibitor use. Conclusions This study highlights evolving trends in P2Y12 inhibitor prescriptions, driven by patient demographics, clinical factors, and updated guidelines. In this Portuguese registry, clopidogrel was the most frequently prescribed second antiplatelet agent in patients who underwent PCI after ACS. However, a notable decline in clopidogrel use was observed over time, coinciding with an increase in ticagrelor prescriptions, which has since become the predominant choice.
Neves et al. (Sat,) reported a other. From 2011-2023 in the ProACS registry, clopidogrel use after ACS PCI decreased as ticagrelor use rose post-2015 to become the predominant P2Y12 inhibitor.