Key result
P2Y12 reloading in NSTEACS patients on chronic therapy is linked to ~65% lower in-hospital MACE.
Why the study?
The association between P2Y12 receptor inhibitor reloading and in-hospital outcomes in NSTEACS patients receiving chronic P2Y12 inhibitor therapy remained undetermined.
Does reloading of P2Y12 inhibitors reduce in-hospital MACE in NSTEACS patients already on chronic P2Y12 receptor inhibitors therapy?
Observational (n=4,790)
Yes
Does reloading of P2Y12 inhibitors reduce in-hospital MACE in NSTEACS patients already on chronic P2Y12 receptor inhibitors therapy?
In NSTEACS patients already on chronic P2Y12 inhibitors, reloading was associated with lower in-hospital MACE and no increase in major bleeding, though baseline differences strongly confounded the results.
May support reloading in chronic P2Y12 users with NSTEACS; leaves open need for randomized confirmation before practice change.
BACKGROUND: The association between P2Y12 receptor inhibitors reloading and in-hospital outcomes in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients who were on chronic P2Y12 receptor inhibitors therapy remained underdetermined. METHODS: The Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS project) is a national registry active from November 2014 to December 2019. 4790 NSTEACS patients on chronic P2Y12 receptor inhibitors therapy were included. Cox proportional hazard models, Kaplan-Meier curves, and subgroup analyses were conducted. RESULTS: The NSTEACS patients who received reloading of P2Y12 receptor inhibitors were younger and had fewer comorbid conditions. The reloading group had a lower risk of major adverse cardiac events (MACE) (0.51% vs. 1.43%, P = 0.007), and all-cause death (0.36% vs. 0.99%, P = 0.028), the risks of myocardial infarction and major bleeding were not significantly different between patients with and without reloading. In survival analysis, a lower cumulative risk of MACE could be identified (Log-rank test, P = 0.007) in reloading group. In the unadjusted Cox model, reloading P2Y12 receptor inhibitors was associated with a decreased risk of MACE [HR, 0.35; 95% CI 0.16-0.78; (P = 0.010)] and all-cause death [HR, 0.37; 95% CI 0.14-0.94; (P = 0.036)]. Reloading of P2Y12 receptor inhibitors was associated with a decreased risk of MACE in most of the subgroups. CONCLUSIONS: In NSTEACS patients already taking P2Y12 receptor inhibitors, we observed a decreased risk of in-hospital MACEs and all-cause mortality and did not observe an increased risk of major bleeding, with reloading. The differential profile in the two groups might influence this association and further studies are warranted. CLINICAL TRIAL REGISTRATION: https://www. CLINICALTRIALS: gov (Unique identifier: NCT02306616, date of first registration: 03/12/2014).
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Wang et al. (2023) conducted an observational in Non-ST-segment elevation acute coronary syndrome (NSTEACS) (n=4,790). Reloading of P2Y12 receptor inhibitors vs. Non-reloading of P2Y12 receptor inhibitors was evaluated on In-hospital major adverse cardiovascular events (MACE) (HR 0.35, 95% CI 0.16-0.78, p=0.010). Reloading of P2Y12 receptor inhibitors in NSTEACS patients already on chronic therapy was associated with a decreased risk of in-hospital MACE (HR 0.35) compared to no reloading.
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