Key result
Novel P2Y12 inhibitors were associated with a lower unadjusted rate of cardiovascular events, major bleeding, or death (7.6% vs 11%, HR 0.67; 95% CI 0.43-1), which lost significance after adjustment.
Why the study?
Do novel P2Y12 inhibitors reduce cardiovascular events, major bleeding, and/or death compared to clopidogrel in real-world patients with acute myocardial infarction undergoing percutaneous intervention?
Cohort (n=1,093)
Yes
Do novel P2Y12 inhibitors reduce cardiovascular events, major bleeding, and/or death compared to clopidogrel in real-world patients with acute myocardial infarction undergoing percutaneous intervention?
Hazard Ratio: 0.67 (95% CI 0.43–1)
Absolute Event Rate: 7.6% vs 11%
p-value: p=0.05
Real-world data reveals a treatment paradox where high-risk AMI patients are less likely to receive novel P2Y12 inhibitors despite potential clinical benefits.
Adjusted results show no difference; leaves open benefit of novel P2Y12 inhibitors in randomized trials.
OBJECTIVE: To assess the real-world use, clinical outcomes, and adherence to novel P2Y12 inhibitors. METHODS: We evaluated 1,093 consecutive acute myocardial infarction patients undergoing a percutaneous intervention. Patients were derived from a prospective, multicenter, nationwide registry and were followed for 30 days; 381 patients (35%) received clopidogrel, 468 (43%) received prasugrel, and 244 (22%) received ticagrelor. Patients treated with clopidogrel were older and more likely to suffer from chronic renal failure and stroke and/or present with non-ST-elevation myocardial infarction (NSTEMI) (p < 0.01 for all). Independent predictors of undertreatment with novel P2Y12 inhibitors included: older age (OR 0.17; 95% CI 0.1-0.27, p < 0.0001), a prior stroke (OR 0.41; 95% CI 0.2-0.68, p = 0.008), and NSTEMI (OR 0.37; 95% CI 0.26-0.54, p < 0.0001). RESULTS: Novel P2Y12 inhibitors were associated with a lower incidence of cardiovascular events, major bleeding, and/or death (7.6 vs.11%, HR 0.67; 95% CI 0.43-1, p = 0.05). However, after a multivariate analysis this trend was not statistically significant. Patients discharged with ticagrelor versus thienopyridines demonstrated a higher rate of crossover to other P2Y12 inhibitors (11 vs. 5%, p = 0.03). CONCLUSIONS: In a real-world cohort, there was an underutilization of novel P2Y12 inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P2Y12 inhibitors at least as much as other patients.
No takes yet. Share an insight, caveat, or question.
Beigel et al. (2016) conducted a cohort in acute myocardial infarction (n=1,093). Novel P2Y12 inhibitors vs. clopidogrel was evaluated on cardiovascular events, major bleeding, and/or death (HR 0.67, 95% CI 0.43-1, p=0.05). Novel P2Y12 inhibitors were associated with a lower unadjusted rate of cardiovascular events, major bleeding, or death (7.6% vs 11%, HR 0.67; 95% CI 0.43-1), which lost significance after adjustment.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: