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Impact of Society Guidelines on Trends in Use of Newer P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Mohamed, Mohamed O; Kontopantelis, Evangelos; Alasnag, Mirvat; Abid, Leila; Banerjee, Amitava; Sharp, Andrew S P; Bourantas, Christos; Sirker, Alex; Curzen, Nick; Mamas, Mamas A


Mohamed O Mohamed

Evangelos Kontopantelis

Mirvat Alasnag

Leila Abid

Amitava Banerjee

Andrew S P Sharp

Christos Bourantas

Alex Sirker

Nick Curzen


Over the past decade, major society guidelines have recommended the use of newer P2Y inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice. All percutaneous coronary intervention procedures (n=534 210) for acute coronary syndrome in England and Wales (April 1, 2010, to March 31, 2022) were retrospectively analyzed, stratified by choice of preprocedural P2Y inhibitor (clopidogrel, ticagrelor, and prasugrel). Multivariable logistic regression models were used to examine odds ratios of receipt of ticagrelor and prasugrel (versus clopidogrel) over time, and predictors of their receipt. Overall, there was a significant increase in receipt of newer P2Y inhibitors from 2010 to 2020 (2022 versus 2010: ticagrelor odds ratio, 8.12 [95% CI, 7.67-8.60]; prasugrel odds ratio, 6.14 [95% CI, 5.53-6.81]), more so in ST-segment-elevation myocardial infarction than non-ST-segment-elevation acute coronary syndrome indication. The most significant increase in odds of receipt of prasugrel was observed between 2020 and 2022 ( <0.001), following a decline/plateau in its use in earlier years (2011-2019). In contrast, the odds of receipt of ticagrelor significantly increased in earlier years (2012-2017, <0.001), after which the trend was stable ( =0.093). Over a 13-year-period, there has been a significant increase in use of newer P2Y inhibitors, although uptake of prasugrel use remained significantly lower than ticagrelor. Earlier society guidelines (pre-2017) were associated with the highest rates of ticagrelor use for non-ST-segment-elevation acute coronary syndrome and ST-segment-elevation myocardial infarction cases while the ISAR-REACT 5 (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome) trial and later society guidelines were associated with higher prasugrel use, mainly for ST-segment-elevation myocardial infarction indication.


Mohamed, M. O., Kontopantelis, E., Alasnag, M., Abid, L., Banerjee, A., Sharp, A. S. P., …Mamas, M. A. (2024). Impact of Society Guidelines on Trends in Use of Newer P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Journal of the American Heart Association, 13(9), Article e034414.

Journal Article Type Article
Acceptance Date Apr 4, 2024
Online Publication Date May 3, 2024
Publication Date May 7, 2024
Deposit Date May 20, 2024
Journal Journal of the American Heart Association
Electronic ISSN 2047-9980
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 13
Issue 9
Article Number e034414
Keywords England, outcomes, Guideline Adherence - trends, Retrospective Studies, Male, Clopidogrel - therapeutic use, Platelet Aggregation Inhibitors - therapeutic use, Female, newer P2Y12 inhibitors, Ticagrelor - therapeutic use, Humans, acute coronary syndrome,
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