Key result
Initiation of P2Y12 inhibitors after first-time myocardial infarction was 93.4% in patients treated with PCI, compared to 49.0% with CABG and 51.5% with medical therapy alone.
Why the study?
The study aimed to analyse initiation of and persistence with P2Y12 inhibitors after first-time myocardial infarction according to revascularization strategy.
What are the rates and predictors of initiation and persistence with P2Y12 inhibitors after first-time MI according to revascularization strategy?
Cohort (n=79,597)
Yes
What are the rates and predictors of initiation and persistence with P2Y12 inhibitors after first-time MI according to revascularization strategy?
Absolute Event Rate: 93.4% vs 51.5%
Initiation of P2Y12 inhibitors after first-time MI is highly dependent on revascularization strategy, with high rates in PCI patients but suboptimal rates in those treated with CABG or medical therapy alone.
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.
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Tajchman et al. (2021) conducted a cohort in first-time myocardial infarction (n=79,597). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass graft (CABG) or medical therapy alone (MTA) was evaluated on Initiation of P2Y12 inhibitors. Initiation of P2Y12 inhibitors after first-time myocardial infarction was 93.4% in patients treated with PCI, compared to 49.0% with CABG and 51.5% with medical therapy alone.
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