Author + information
- Dimitrios Alexopoulos,
- Ioanna Xanthopoulou,
- Evropi Tsoni,
- Ioannis Ntalas,
- Spyridon Deftereos,
- George Sitafidis,
- Periklis Davlouros,
- Vlassis Pyrgakis,
- Ioannis Goudevenos and
- Filippos Triposkiadis
Scarce data exist about in-hospital P2Y12 inhibitor switching in patients with acute coronary syndrome (ACS).
We performed detailed recording of in-hospital P2Y12 inhibitor switching in ACS patients undergoing percutaneous coronary intervention (PCI), in the context of a prospective multi-centre, observational study of contraindications to P2Y12 inhibitors and antiplatelet treatment patterns in ACS patients subjected to PCI in Greece.
From January to August 2012, 873 patients were included in analysis. Switching of P2Y12 inhibitor took place in 333(38.1%) patients. Patients with switching subjected less frequently to primary PCI (42.9% vs 64.9%, p<0.001), were younger (59.7±11.3 vs 63.1±12.6, p<0.001), more often on chronic clopidogrel use (15.9% vs 10.7%, p=0.03) and more often transferred from non-PCI hospital (70.9% vs 57.6%, p<0.001) compared to those without switching. Upgrade from clopidogrel to a more potent agent (prasugrel or ticagrelor) was observed in 294(88.3%) cases, while downgrade from prasugrel or ticagrelor to clopidogrel in 21(6.3%). In multivariate logistic regression analysis admission with ST elevation myocardial infarction and renal failure but not P2Y12 downgrade predicted in-hospital major adverse cardiovascular (OR=2.81, p=0.03, OR=6.72, p=0.004, OR=1.75, p=0.6 respectively). Age ≥75 years and history of bleeding but not P2Y12 upgrade predicted in-hospital bleeding according to BARC classification (OR=2.04, p=0.01, OR=4.41, p<0.001 OR=1.31, p=0.28 respectively).
In-hospital switching of P2Y12 inhibitor occurs frequently and, in most cases, represents upgrade from clopidogrel to prasugrel or ticagrelor. In-hospital switching of antiplatelet therapy is not associated with increased risk of in-hospital MACEs or bleeding events.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: ACS Therapy: Antiplatelet Agents
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1129–203
- 2013 American College of Cardiology Foundation