Author + information
- Alexander C. Fanaroff,
- Lisa A. Kaltenbach,
- Eric Peterson,
- Mohammed Akhter,
- Mark B. Effron,
- Timothy Henry and
- Tracy Wang
Background: P2Y12 inhibitor therapy is recommended for 1 year post-MI, yet little guidance is provided on antiplatelet management for patients with recurrent ischemic events during that year.
Methods: The TRANSLATE-ACS study enrolled 12,365 MI patients treated with PCI; we examined the 1,414 patients (11%) with recurrent MI or unplanned PCI/CABG during the first year post-MI. We described P2Y12 inhibitor change after the recurrent ischemic event, and modeled factors associated with P2Y12 intensification (clopidogrel switched to prasugrel/ticagrelor).
Results: In the first year post-MI, 1,414 patients had a total of 1,740 recurrent ischemic events (771 MIs with or without revascularization, 969 revascularizations without MI). Median time to the first recurrent ischemic event was 154 days (IQR 55, 287) and 9.5% of recurrent events involved stent thrombosis. Only 101 (9.3%) of the 1092 recurrent ischemic events occurring in clopidogrel-treated patients led to P2Y12 intensification. Recurrent events involving stent thrombosis or MI were the strongest factors associated with P2Y12 intensification (Figure, c-index 0.77), yet only 36% of clopidogrel-treated patients with stent thrombosis had P2Y12 intensification. Increasing age and longer time from the index MI were associated with lower likelihood for intensification.
Conclusions: Among post-MI patients with a recurrent ischemic event, intensification of antiplatelet therapy was rare, even among patients with stent thrombosis.
Moderated Poster Contributions
Acute and Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:15 p.m.-1:25 p.m.
Session Title: Anti-Platelet Therapies: Always a Sticky Topic
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1227M-09
- 2017 American College of Cardiology Foundation