The reasons for postdischarge adenosine diphosphate receptor inhibitor (ADPri) switching among patients with myocardial infarction (MI) are unclear. We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary intervention. Methods We used TRANSLATE-ACS (2010-2012) data to assess postdischarge ADPri switching among 8,672 MI patients discharged after percutaneous coronary intervention who remained on ADPri therapy 1 year post-MI. We examined patient-reported reasons for switching, GUSTO moderate or severe bleeding, major adverse cardiovascular events (MACEs), and definite stent thrombosis events around the time of the switch. Results Among patients still on ADPri therapy 1 year post-MI, 663 (7.6%) switched ADPri during that year. Switching occurred at a median of 50 days postdischarge and most frequently in patients discharged on ticagrelor (64/226; 28.3%), followed by prasugrel (383/2,489; 15.4%) and clopidogrel (216/5,957; 3.6%) (P <.001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel and 87.5% of ticagrelor switches were to clopidogrel; both of these groups most often cited cost as a reason for switching (43.6% and 39.1%, respectively), whereas 60.7% who switched from clopidogrel cited physician decision as a reason. In the 7 days preceding the switch from clopidogrel, 40 (18.5%) had a MACE and 12 (5.6%) had a definite stent thrombosis event, whereas that from prasugrel or ticagrelor, a GUSTO moderate or severe bleeding event occurred in 1 (0.3%) and 0 patients, respectively. Conclusions Postdischarge ADPri switching occurred infrequently within the first year post-MI and uncommonly was associated with MACEs or bleeding events.
Bibliographical noteFunding Information:
Dr Zettler reports being a shareholder of Eli Lilly and Company. Dr Peterson reports grant support from American College of Cardiology, American Heart Association, and Janssen, and consulting from Bayer, Boehringer Ingelheim, Merck, Valeant, Sanofi, Astra Zeneca, Janssen, Regeneron, and Genentech. Dr Effron reports being an employee of Eli Lilly and Company at the time of the study and a shareholder of Eli Lilly and Company (significant). Dr Henry reports honoraria from Eli Lilly and Daiichi Sankyo. Dr Baker reports being an employee of Daiichi Sankyo, Inc (significant). Dr Cohen reports research grant support from Eli Lilly, Daiichii Sankyo, and Astra Zeneca; consulting fees from Eli Lilly and Astra Zeneca; and speaking honoraria from Eli Lilly and Astra Zeneca. Dr Wang reports research funding from AstraZeneca, Gilead, Lilly, The Medicines Company, and Canyon Pharmaceuticals (all significant); educational activities or lectures (generates money for Duke) for AstraZeneca (modest); and consulting (including CME) for Medco (modest) and American College of Cardiology (significant). Ms McCoy, Dr Anstrom, and Dr Messenger have no relevant disclosures to report.