Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Eur Heart J Acute Cardiovasc Care. 2021 Oct 1;10(7):774-786. doi: 10.1093/ehjacc/zuab043.
We aimed to analyse initiation of and persistence with P2Y12 inhibitors after first-time myocardial infarction (MI).
Using Danish nationwide registries, we identified patients ≥30 years with first-time MI during 1 January 2005-30 June 2016 and subsequent prescriptions of P2Y12 inhibitors. Independent factors related to initiation of and persistence with P2Y12 inhibitors were analysed by multivariable logistic regression and a Cox proportional hazards model. Patients were stratified by revascularization strategy: percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical therapy alone (MTA). Overall, 79 597 MI patients were included with 39 172 undergoing PCI, 2619 CABG, and 16 640 MTA, showing initiation of P2Y12 inhibitors of 93.4%, 49.0%, and 51.5%, respectively. Congestive heart failure, cerebrovascular disease, cardiac dysrhythmias, renal failure, previous bleeding, and oral anticoagulants were associated with less initiation of P2Y12 inhibitors. Female sex was associated with less initiation of P2Y12 inhibitors following MTA. MTA, coronary angiography, cerebrovascular disease, diabetes with complications, previous bleeding, antidiabetics, and ticagrelor as P2Y12 inhibitor were associated with non-persistence, whereas female sex, advanced age, and concomitant pharmacotherapy with angiotensin-converting enzyme inhibitors, beta-blockers, statins, oral anticoagulants, and aspirin were associated with high persistence.
Initiation of P2Y12 inhibitors in PCI-treated MI patients was high in contrast to those treated with CABG or MTA and patients with certain comorbidities. Further studies on the benefit-risk ratio of P2Y12 inhibitors in CABG-treated or MTA-treated patients and patients with comorbidities after first-time MI are warranted, as is focus on persistence among patients receiving MTA, patients with comorbidities, and users of ticagrelor.
本研究旨在分析首次心肌梗死（MI）后 P2Y12 抑制剂的起始使用和持续使用情况。
利用丹麦全国性注册登记，我们纳入了 2005 年 1 月 1 日至 2016 年 6 月 30 日期间首次发生 MI 且随后开具 P2Y12 抑制剂处方的年龄≥30 岁的患者。采用多变量逻辑回归和 Cox 比例风险模型分析与 P2Y12 抑制剂起始使用和持续使用相关的独立因素。根据血运重建策略对患者进行分层：经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）或单纯药物治疗（MTA）。共有 79597 例 MI 患者纳入本研究，其中 39172 例患者接受 PCI，2619 例患者接受 CABG，16640 例患者接受 MTA，相应的 P2Y12 抑制剂起始使用率分别为 93.4%、49.0%和 51.5%。充血性心力衰竭、脑血管疾病、心律失常、肾功能衰竭、既往出血和口服抗凝剂与 P2Y12 抑制剂起始使用减少相关。女性与 MTA 后 P2Y12 抑制剂起始使用减少相关。MTA、冠状动脉造影、脑血管疾病、合并糖尿病并发症、既往出血、降糖药和替格瑞洛作为 P2Y12 抑制剂与非持续使用相关，而女性、高龄、同时应用血管紧张素转换酶抑制剂、β受体阻滞剂、他汀类药物、口服抗凝剂和阿司匹林与高持续使用相关。
与接受 CABG 或 MTA 治疗的 MI 患者相比，接受 PCI 治疗的 MI 患者 P2Y12 抑制剂的起始使用率较高，某些合并症患者也是如此。需要进一步研究首次 MI 后 CABG 或 MTA 治疗患者以及合并症患者使用 P2Y12 抑制剂的获益-风险比，还需要关注接受 MTA 治疗、合并症患者以及使用替格瑞洛的患者的药物持续使用情况。
