Zettler Marjorie E, Peterson Eric D, McCoy Lisa A, Effron Mark B, Anstrom Kevin J, Henry Timothy D, Baker Brian A, Messenger John C, Cohen David J, Wang Tracy Y
Eli Lilly & Company, Indianapolis, IN.
Duke Clinical Research Institute, Durham, NC.
Am Heart J. 2017 Jan;183:62-68. doi: 10.1016/j.ahj.2016.10.006. Epub 2016 Oct 15.
The reasons for postdischarge adenosine diphosphate receptor inhibitor (ADPri) switching among patients with myocardial infarction (MI) are unclear. We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary intervention.
We used TRANSLATE-ACS (2010-2012) data to assess postdischarge ADPri switching among 8,672 MI patients discharged after percutaneous coronary intervention who remained on ADPri therapy 1 year post-MI. We examined patient-reported reasons for switching, GUSTO moderate or severe bleeding, major adverse cardiovascular events (MACEs), and definite stent thrombosis events around the time of the switch.
Among patients still on ADPri therapy 1 year post-MI, 663 (7.6%) switched ADPri during that year. Switching occurred at a median of 50 days postdischarge and most frequently in patients discharged on ticagrelor (64/226; 28.3%), followed by prasugrel (383/2,489; 15.4%) and clopidogrel (216/5,957; 3.6%) (P < .001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel and 87.5% of ticagrelor switches were to clopidogrel; both of these groups most often cited cost as a reason for switching (43.6% and 39.1%, respectively), whereas 60.7% who switched from clopidogrel cited physician decision as a reason. In the 7 days preceding the switch from clopidogrel, 40 (18.5%) had a MACE and 12 (5.6%) had a definite stent thrombosis event, whereas that from prasugrel or ticagrelor, a GUSTO moderate or severe bleeding event occurred in 1 (0.3%) and 0 patients, respectively.
Postdischarge ADPri switching occurred infrequently within the first year post-MI and uncommonly was associated with MACEs or bleeding events.
心肌梗死（MI）患者出院后转换二磷酸腺苷受体抑制剂（ADPri）的原因尚不清楚。我们试图描述接受经皮冠状动脉介入治疗的急性心肌梗死患者出院后ADPri转换的发生率和模式。
我们使用TRANSLATE - ACS（2010 - 2012年）数据，评估8672例经皮冠状动脉介入治疗后出院且在心肌梗死后1年仍接受ADPri治疗的MI患者出院后ADPri的转换情况。我们研究了患者报告的转换原因、GUSTO中度或重度出血、主要不良心血管事件（MACE）以及转换前后的明确支架血栓形成事件。
在心肌梗死后1年仍接受ADPri治疗的患者中，663例（7.6%）在该年内转换了ADPri。转换发生在出院后中位数50天，最常发生在接受替格瑞洛出院的患者中（64/226；28.3%），其次是普拉格雷（383/2489；15.4%）和氯吡格雷（216/5957；3.6%）（P < 0.001）。在接受普拉格雷出院的患者中，97.3%的转换是转换为氯吡格雷，87.5%的替格瑞洛转换是转换为氯吡格雷；这两组最常将费用作为转换原因（分别为43.6%和39.1%），而从氯吡格雷转换的患者中有60.7%将医生的决定作为原因。在从氯吡格雷转换前的7天内，40例（18.5%）发生了MACE，12例（5.6%）发生了明确的支架血栓形成事件，而从普拉格雷或替格瑞洛转换的患者中，分别有未发生GUSTO中度或重度出血事件（0例）和1例（0.3%）。
心肌梗死后第一年内出院后ADPri转换很少发生，且很少与MACE或出血事件相关。
