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Potent P2Y(12) inhibitors in patients with acute myocardial infarction and cardiogenic shock

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Author(s)
Jinhwan JoSeung Hun LeeHyun Sung JohHyun Kuk KimJu Han KimYoung Joon HongYoung Keun AhnMyung Ho JeongSeung Ho HurDoo-Il KimKiyuk ChangHun Sik ParkJang-Whan BaeJin-Ok JeongYong Hwan ParkKyeong Ho YunChang-Hwan YoonYisik KimJin-Yong HwangHyo-Soo KimWoochan KwonDoosup ShinJunho HaChang Hoon KimKi Hong ChoiTaek Kyu ParkJeong Hoon YangYoung Bin SongJoo-Yong HahnSeung-Hyuk ChoiHyeon-Cheol GwonJoo Myung Lee
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
Crit Care
Issued Date
2025
Volume
29
Keyword
Acute myocardial infarctionCardiogenic shockP2Y12 inhibitorsMajor cardiovascular eventBleeding
Abstract
Background:
Although potent P2Y12 inhibitors, such as ticagrelor and prasugrel, are standard treatment in patients with acute myocardial infarction (AMI), evidence for their efficacy and safety compared with clopidogrel is limited in patients with AMI complicated by cardiogenic shock.

Methods:
Among 28,949 patients from the nationwide pooled registry of KAMIR-NIH and KAMIR-V, a total of 1482 patients (5.1%) with AMI and cardiogenic shock who underwent percutaneous coronary intervention of the culprit vessel were selected. Primary outcome was major adverse cardiovascular event (MACE, a composite of cardiac death, MI, repeat revascularization and definite stent thrombosis) and major secondary outcome was Bleeding Academic Research Consortium (BARC) type 2 or greater bleeding at 2 years.

Results:
Among the study population, 537 patients (36.2%) received potent P2Y12 inhibitors and 945 patients (63.8%) received clopidogrel after index procedure. The risk of MACE was significantly lower in the potent P2Y12 inhibitors group than in the clopidogrel group (16.6% versus 24.7%; adjusted hazard ratio [HR], 0.76 [95% CI 0.59–0.99]; P = 0.046). Regarding BARC type 2 or greater bleeding, there was no significant difference between the potent P2Y12 inhibitors group and the clopidogrel group (12.5% versus 10.7%; adjusted HR, 1.36 [95% CI 0.98–1.88]; P = 0.064). Significant interaction was observed in patients aged ≥ 75 years (interaction P = 0.021) or venoarterial extracorporeal membrane oxygenator (VA-ECMO) use (interaction P = 0.015) for significantly increased risk of BARC type 2 or greater bleeding following the use of potent P2Y12 inhibitors.

Conclusions:
In patients with AMI complicated by cardiogenic shock, the use of potent P2Y12 inhibitors was associated with a lower risk of MACE compared with clopidogrel, without an increased risk of BARC type 2 or greater bleeding. The current data supports the use of potent P2Y12 inhibitors in patients with AMI and cardiogenic shock, except in patients aged ≥ 75 years or receiving VA-ECMO support.
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1466-609X
Source
https://ccforum.biomedcentral.com/articles/10.1186/s13054-025-05277-y
DOI
10.1186/s13054-025-05277-y
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/46194
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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