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Thromb Haemost 2018; 118(05): 852-863
DOI: 10.1055/s-0038-1635578
Cellular Haemostasis and Platelets
Schattauer GmbH Stuttgart

Early P2Y12 Inhibitors Escalation in Primary PCI Patients: Insights from the RENOVAMI Registry

Alessandro Lupi
1   Division of Cardiology, ASL VCO, Verbania, Italy
,
Roberta Della Bona
2   Department of Cardiology, Policlinico Casilino, Rome, Italy
,
Emanuele Meliga
3   Interventional Cardiology Unit, Mauriziano Hospital, Turin, Italy
,
Davide Capodanno
4   Department of Cardio-Thoracic-Vascular, Ferrarotto Hospital, University of Catania, Catania, Italy
,
Alon Schaffer
1   Division of Cardiology, ASL VCO, Verbania, Italy
,
Angelo S. Bongo
5   2nd Division of Cardiology, “Maggiore della Carità” University Hospital, Novara, Italy
,
Giovanni Gaudio
6   Medicina Interna, Presidio Ospedaliero Somma Lombardo, Lombardo, Italy
,
Luigina Guasti
7   Research Center on Dyslipidemia, University of Insubria, Varese, Italy
,
Dimitrios Alexopoulos
8   Attikon University Hospital, National and Capodistrian University of Athens, Athens, Greece
,
Marco Valgimigli
9   Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
,
Italo Porto
10   Interventional Cardiology Unit, Department of Cardiovascular Sciences, UCSC, Rome, Italy
› Author Affiliations Funding None.
Further Information

Publication History

26 September 2017

26 February 2018

Publication Date:
04 April 2018 (online)

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Abstract

Background Early escalation from clopidogrel to new generation P2Y12 inhibitors is common practice in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Real-world data about this strategy, however, are limited.

Methods From 2012 to 2015, 1,057 consecutive STEMI patients treated with pPCI in an Italian hub-and-spoke network were prospectively included in an observational registry (RENOVAMI, ClinicalTrials.gov Identifier: NCT01760382). We compared the prevalence, predictive factors and in-hospital outcomes of patients escalated to a new generation P2Y12 inhibitor within the first 24 hours from pPCI with those continuing on admission antiplatelet therapy.

Results In the first 24 hours after pPCI, 165 patients (15.6%) were escalated from clopidogrel to a new generation P2Y12 inhibitor, while de-escalation to clopidogrel was occasional (19 patients, 1.8%) and switch between new generation P2Y12 inhibitors was rare (8 patients, 0.8%, all from ticagrelor to prasugrel). Drug eluting stent use (adjusted odds ratio [OR], 2.19, 95% confidence interval [CI], 1.55–3.08, p = 0.0002) and impaired renal function (adjusted OR, 0.19, 95% CI, 0.05–0.77, p = 0.02) were the only independent predictive factors for the decision to escalate. After adjustment for potential confounders, escalation did not predict in-hospital outcomes, whereas the overall use of new generation P2Y12 inhibitors was correlated with a better in-hospital survival (adjusted hazard ratio, 0.47, 95% CI, 0.25–0.91, p = 0.03). Moreover, escalation did not influence bleeding rates.

Conclusions In this prospective registry of STEMI patients treated with pPCI and contemporary antiplatelet therapy, early escalation to a new generation P2Y12 inhibitor appeared safe and did not significantly affect in-hospital bleeding rates.

Keywords

antiplatelet therapy - clopidogrel - ticagrelor - prasugrel - STEMI - primary PCI - antiplatelet therapy escalation
 

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