Contemporary Trends in High-Potency P2Y12 Receptor Inhibitor Use Among Patients With Acute Myocardial Infarction...

Area of Science:

• Cardiology
• Pharmacology
• Health Services Research

Background:

• High-potency P2Y12 inhibitors (ticagrelor, prasugrel) improve ischemic outcomes in acute myocardial infarction (AMI) patients post-percutaneous coronary intervention (PCI) compared to clopidogrel.
• Understanding trends in high-potency P2Y12 inhibitor use is crucial for optimizing patient care.

Purpose of the Study:

• To analyze contemporary trends in the utilization of high-potency P2Y12 inhibitors versus clopidogrel.
• To identify key predictors associated with the selection of these agents in AMI patients undergoing PCI.

Main Methods:

• Observational study utilizing electronic health records from over 95 US healthcare organizations.
• Included adult patients with AMI undergoing PCI between 2016 and 2023.
• Multivariable logistic regression analyzed predictors of P2Y12 inhibitor selection.

Main Results:

• Clopidogrel remained most prescribed (55.2%), but its use declined from 66.2% (2016) to 51.4% (2023).
• Ticagrelor use increased from 27.8% to 39.4%, and prasugrel from 6.0% to 9.2% during the study period.
• High-potency agents were more common in younger patients, those with prior PCI/MI, chronic kidney disease, and morbid obesity.

Conclusions:

• The prescription of high-potency P2Y12 inhibitors for AMI patients undergoing PCI is on the rise.
• Prasugrel use saw a notable increase post-2019, influenced by clinical trial results and guideline updates.
• These trends indicate a dynamic shift in P2Y12 inhibitor prescribing practices.