Effect of de-escalated P2Y12 inhibitor switching in dual antiplatelet therapy (DAPT)

Main Takeaway

A real-word study of Taiwanese patients with AMI undergoing PC

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;

Study Design

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

Key Outcomes:

• Death, AMI readmission, and MACE within one year during the follow-up period

Key Results

Limitations

• 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.

MAT-BH-2200185/v2/Jun 2023