Related Experiment Video
Updated: Mar 19, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Contemporary Trends in High-Potency P2Y12 Receptor Inhibitor Use Among Patients With Acute Myocardial Infarction
Ayman R Fath1,2, Binish Qureshi1, Amro Aglan3
1Division of Cardiology University of Texas Health Science Center San Antonio TX USA.
Insights
High-potency P2Y12 inhibitors are increasingly used for acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Their use rose significantly, with prasugrel adoption accelerating after 2019.
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.
Background:
High-potency P2Y12 receptor inhibitors (ticagrelor and prasugrel) reduce ischemic outcomes compared with clopidogrel among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). This study aims to examine contemporary trends and identify predictors of their use among patients with AMI undergoing PCI in the United States.
Methods:
This observational study used electronic health records from >95 US-based health care organizations. Adults with AMI who underwent PCI between 2016 and 2023 were included. The primary outcome was the prescription of high-potency P2Y12 receptor inhibitors versus clopidogrel. Multivariable logistic regression was used to identify independent predictors of P2Y12 inhibitor selection.
Results:
Among 182 986 patients with AMI who underwent PCI, clopidogrel was the most prescribed P2Y12 receptor inhibitor (101 136 patients, 55.2%), followed by ticagrelor (68 350, 37.4%) and prasugrel (13 500, 7.4%). Clopidogrel use declined from 66.2% in 2016 to 51.4% in 2023 (Ptrend=0.002), whereas ticagrelor use increased from 27.8% to 39.4% (Ptrend=0.022), and prasugrel use increased from 6.0% to 9.2% (Ptrend=0.008), predominantly after 2019. High-potency P2Y12 receptor inhibitors were more frequently used in younger patients (<60 years), those with prior PCI, prior MI, chronic kidney disease, and morbid obesity.
Conclusions:
Among patients with AMI undergoing PCI, the use of high-potency agents continues to rise. Prasugrel use increased notably after 2019, following the ISAR-REACT 5 (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome) trial and the European guideline updates. These findings reflect an evolving prescribing landscape of P2Y12 receptor inhibitors in contemporary practice.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:27Coronary Artery Disease V: Interprofessional Care
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...