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Abstract：
BACKGROUND: Over the past decade, major society guidelines have recommended the use of newer P2Y12 inhibitors over clopidogrel for those undergoing percutaneous coronary intervention for acute coronary syndrome. It is unclear what impact these recommendations had on clinical practice.
RESULTS: 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 P2Y12 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 P2Y12 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 (P<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, Ptrend<0.001), after which the trend was stable (Ptrend=0.093).
CONCLUSIONS: Over a 13-year-period, there has been a significant increase in use of newer P2Y12 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.
RESULTS: 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 P2Y12 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 P2Y12 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 (P<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, Ptrend<0.001), after which the trend was stable (Ptrend=0.093).
CONCLUSIONS: Over a 13-year-period, there has been a significant increase in use of newer P2Y12 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.
摘要：
背景：在过去的十年中，主要社会指南建议接受急性冠状动脉综合征经皮冠状动脉介入治疗的患者使用较新的P2Y12抑制剂,而不是氯吡格雷.目前尚不清楚这些建议对临床实践有何影响。
结果：回顾性分析了英格兰和威尔士（2010年4月1日至2022年3月31日）急性冠状动脉综合征的所有经皮冠状动脉介入治疗程序（n=534210），根据术前P2Y12抑制剂的选择进行分层(氯吡格雷，替格瑞洛,和普拉格雷）。使用多变量逻辑回归模型来检验替格瑞洛和普拉格雷（相对于氯吡格雷）随时间的接受比值比，和预测他们的收据。总的来说,从2010年到2020年，新型P2Y12抑制剂的接收量显著增加(2022年与2010年相比：替格瑞洛比值比，8.12[95%CI，7.67-8.60]；普拉格雷赔率比，6.14[95%CI，5.53-6.81])，ST段抬高型心肌梗死与非ST段抬高型急性冠脉综合征指征相比更为明显.在2020年至2022年之间，收到普拉格雷的几率显着增加（P<0.001），在早些年（2011-2019年）使用下降/平稳之后。相比之下,早期收到替格瑞洛的几率显着增加（2012-2017年，Ptrend<0.001），之后趋势稳定(Ptrend=0.093)。
结论：在13年的时间里，新型P2Y12抑制剂的使用显着增加，尽管普拉格雷的摄入量仍然显著低于替格瑞洛。较早的社会指南（2017年之前）与非ST段抬高急性冠脉综合征和ST段抬高心肌梗死病例的替格瑞洛使用率最高，而ISAR-REACT5（前瞻性，替格瑞洛与普拉格雷在急性冠脉综合征患者中的随机试验)试验和后来的社会指南与较高的普拉格雷使用率相关，主要为ST段抬高型心肌梗死指征。
结果：回顾性分析了英格兰和威尔士（2010年4月1日至2022年3月31日）急性冠状动脉综合征的所有经皮冠状动脉介入治疗程序（n=534210），根据术前P2Y12抑制剂的选择进行分层(氯吡格雷，替格瑞洛,和普拉格雷）。使用多变量逻辑回归模型来检验替格瑞洛和普拉格雷（相对于氯吡格雷）随时间的接受比值比，和预测他们的收据。总的来说,从2010年到2020年，新型P2Y12抑制剂的接收量显著增加(2022年与2010年相比：替格瑞洛比值比，8.12[95%CI，7.67-8.60]；普拉格雷赔率比，6.14[95%CI，5.53-6.81])，ST段抬高型心肌梗死与非ST段抬高型急性冠脉综合征指征相比更为明显.在2020年至2022年之间，收到普拉格雷的几率显着增加（P<0.001），在早些年（2011-2019年）使用下降/平稳之后。相比之下,早期收到替格瑞洛的几率显着增加（2012-2017年，Ptrend<0.001），之后趋势稳定(Ptrend=0.093)。
结论：在13年的时间里，新型P2Y12抑制剂的使用显着增加，尽管普拉格雷的摄入量仍然显著低于替格瑞洛。较早的社会指南（2017年之前）与非ST段抬高急性冠脉综合征和ST段抬高心肌梗死病例的替格瑞洛使用率最高，而ISAR-REACT5（前瞻性，替格瑞洛与普拉格雷在急性冠脉综合征患者中的随机试验)试验和后来的社会指南与较高的普拉格雷使用率相关，主要为ST段抬高型心肌梗死指征。
