Abstract 13284: In-Hospital ADP Receptor Inhibitor Switching in Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry®
Background: With several ADP receptor inhibitors now available, little is known regarding patient characteristics associated with in-hospital drug switching.
Methods: We studied 47,040 PCI-treated ACS patients who received either clopidogrel or prasugrel within 24 hours of hospital admission using the ACTION - Get With the GuidelinesTM and CathPCI® registries at 362 U.S. hospitals from July 2009 to June 2011. Hierarchical logistic regression modeling was used to determine factors independently associated with in-hospital ADP receptor inhibitor switching.
Results: Among 40,531 patients treated with clopidogrel at admission, 2,125 (5.2%) were switched in-hospital and discharged on prasugrel, while among 6,509 patients treated with prasugrel at admission, 751 (11.5%) were discharged on clopidogrel. Among those treated initially in-hospital with clopidogrel, switching to prasugrel was associated with clinical (diabetes, home clopidogrel or prasugrel use, in-hospital reinfarction), angiographic (bifurcation lesion, multivessel PCI) and socioeconomic (private health insurance) factors; continuation and discharge on clopidogrel was associated with bleeding risk (older age, prior stroke or TIA, in-hospital CABG) (Figure). Among those treated initially in-hospital with prasugrel, switching to clopidogrel was associated with bleeding risk or observed bleeding events; continuation and discharge on prasugrel was associated with STEMI presentation, treatment with drug eluting stent and private health insurance.
Conclusion: ADP receptor inhibitors are switched in-hospital in approximately 5-10% of ACS patients undergoing PCI. Drug switching appears to be associated with bleeding risk, lesion complexity and socioeconomic considerations. Future studies will assess implications of in-hospital ADP receptor inhibitor switching on clinical outcomes.
- © 2013 by American Heart Association, Inc.