Utility of GRACE and ACUITY-HORIZONS risk scores to guide dual antiplatelet therapy in Korean patients with acute myocardial infarction undergoing drug-eluting stenting

on behalf of the KAMIR-NIH Registry Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Dual antiplatelet therapy (DAPT) is recommended in patients receiving drug-eluting stents (DES). However, bleeding risk should be weighed against ischemic risk. Utility of GRACE risk score and ACUITY-HORIZONS bleeding risk score was assessed in patients with acute myocardial infarction (MI) according to use of P2Y12 blocker. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 7791 patients with acute MI receiving DES were divided into ticagrelor (n = 1554) and clopidogrel (n = 6237) groups. Propensity-matched 12-month mortality and bleeding event rates were compared according to GRACE and ACUITY-HORIZONS scores. Patients who received thrombolysis, prasugrel or anticoagulants, or who discontinued or switched DAPT were excluded. Results: In all patients, high-risk patients more often received clopidogrel. After propensity score matching (n = 1553 in each group), 12-month mortality was not different, but TIMI major bleeding rate was higher with ticagrelor (2.8% vs. 1.4%, p = 0.007). On subgroup analysis, 12-month mortality was lower with ticagrelor in patients with high (>140) compared to low-to-moderate risk GRACE score (5.1% vs. 7.9%, p = 0.04). When combined with ACUITY-HORIZONS bleeding score, 12-month mortality was lower with ticagrelor in patients with high GRACE score but without very high (≥20) ACUITY-HORIZONS score (2.4% vs. 5.3%, p = 0.03). Conclusions: In patients with acute MI receiving DES, GRACE and ACUITY-HORIZONS scores may help guide DAPT. In patients with high GRACE score, a more potent P2Y12 blocker may be considered, particularly in the subset not at very high risk of bleeding.

Original languageEnglish
Pages (from-to)411-419
Number of pages9
JournalJournal of Cardiology
Volume72
Issue number5
DOIs
Publication statusPublished - 2018 Nov

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Myocardial Infarction
Pharmaceutical Preparations
clopidogrel
Hemorrhage
Drug-Eluting Stents
Therapeutics
Mortality
Propensity Score
National Institutes of Health (U.S.)
Korea
Anticoagulants
Registries
Databases
Ticagrelor

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{1e6b5c42d4c44c1aaaf453db3bb9fdad,
title = "Utility of GRACE and ACUITY-HORIZONS risk scores to guide dual antiplatelet therapy in Korean patients with acute myocardial infarction undergoing drug-eluting stenting",
abstract = "Background: Dual antiplatelet therapy (DAPT) is recommended in patients receiving drug-eluting stents (DES). However, bleeding risk should be weighed against ischemic risk. Utility of GRACE risk score and ACUITY-HORIZONS bleeding risk score was assessed in patients with acute myocardial infarction (MI) according to use of P2Y12 blocker. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 7791 patients with acute MI receiving DES were divided into ticagrelor (n = 1554) and clopidogrel (n = 6237) groups. Propensity-matched 12-month mortality and bleeding event rates were compared according to GRACE and ACUITY-HORIZONS scores. Patients who received thrombolysis, prasugrel or anticoagulants, or who discontinued or switched DAPT were excluded. Results: In all patients, high-risk patients more often received clopidogrel. After propensity score matching (n = 1553 in each group), 12-month mortality was not different, but TIMI major bleeding rate was higher with ticagrelor (2.8{\%} vs. 1.4{\%}, p = 0.007). On subgroup analysis, 12-month mortality was lower with ticagrelor in patients with high (>140) compared to low-to-moderate risk GRACE score (5.1{\%} vs. 7.9{\%}, p = 0.04). When combined with ACUITY-HORIZONS bleeding score, 12-month mortality was lower with ticagrelor in patients with high GRACE score but without very high (≥20) ACUITY-HORIZONS score (2.4{\%} vs. 5.3{\%}, p = 0.03). Conclusions: In patients with acute MI receiving DES, GRACE and ACUITY-HORIZONS scores may help guide DAPT. In patients with high GRACE score, a more potent P2Y12 blocker may be considered, particularly in the subset not at very high risk of bleeding.",
author = "{on behalf of the KAMIR-NIH Registry Investigators} and Sim, {Doo Sun} and Jeong, {Myung Ho} and Kim, {Hyo Soo} and Gwon, {Hyeon Cheol} and Seung, {Ki Bae} and Rha, {Seung Woon} and Chae, {Shung Chull} and Kim, {Chong Jin} and Cha, {Kwang Soo} and Park, {Jong Sun} and Yoon, {Jung Han} and Chae, {Jei Keon} and Joo, {Seung Jae} and Choi, {Dong Ju} and Hur, {Seung Ho} and Seong, {In Whan} and Cho, {Myeong Chan} and Kim, {Doo Il} and Oh, {Seok Kyu} and Ahn, {Tae Hoon} and Hwang, {Jin Yong}",
year = "2018",
month = "11",
doi = "10.1016/j.jjcc.2018.04.006",
language = "English",
volume = "72",
pages = "411--419",
journal = "Journal of Cardiology",
issn = "0914-5087",
number = "5",

}

Utility of GRACE and ACUITY-HORIZONS risk scores to guide dual antiplatelet therapy in Korean patients with acute myocardial infarction undergoing drug-eluting stenting. / on behalf of the KAMIR-NIH Registry Investigators.

In: Journal of Cardiology, Vol. 72, No. 5, 11.2018, p. 411-419.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Utility of GRACE and ACUITY-HORIZONS risk scores to guide dual antiplatelet therapy in Korean patients with acute myocardial infarction undergoing drug-eluting stenting

AU - on behalf of the KAMIR-NIH Registry Investigators

AU - Sim, Doo Sun

AU - Jeong, Myung Ho

AU - Kim, Hyo Soo

AU - Gwon, Hyeon Cheol

AU - Seung, Ki Bae

AU - Rha, Seung Woon

AU - Chae, Shung Chull

AU - Kim, Chong Jin

AU - Cha, Kwang Soo

AU - Park, Jong Sun

AU - Yoon, Jung Han

AU - Chae, Jei Keon

AU - Joo, Seung Jae

AU - Choi, Dong Ju

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Cho, Myeong Chan

AU - Kim, Doo Il

AU - Oh, Seok Kyu

AU - Ahn, Tae Hoon

AU - Hwang, Jin Yong

PY - 2018/11

Y1 - 2018/11

N2 - Background: Dual antiplatelet therapy (DAPT) is recommended in patients receiving drug-eluting stents (DES). However, bleeding risk should be weighed against ischemic risk. Utility of GRACE risk score and ACUITY-HORIZONS bleeding risk score was assessed in patients with acute myocardial infarction (MI) according to use of P2Y12 blocker. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 7791 patients with acute MI receiving DES were divided into ticagrelor (n = 1554) and clopidogrel (n = 6237) groups. Propensity-matched 12-month mortality and bleeding event rates were compared according to GRACE and ACUITY-HORIZONS scores. Patients who received thrombolysis, prasugrel or anticoagulants, or who discontinued or switched DAPT were excluded. Results: In all patients, high-risk patients more often received clopidogrel. After propensity score matching (n = 1553 in each group), 12-month mortality was not different, but TIMI major bleeding rate was higher with ticagrelor (2.8% vs. 1.4%, p = 0.007). On subgroup analysis, 12-month mortality was lower with ticagrelor in patients with high (>140) compared to low-to-moderate risk GRACE score (5.1% vs. 7.9%, p = 0.04). When combined with ACUITY-HORIZONS bleeding score, 12-month mortality was lower with ticagrelor in patients with high GRACE score but without very high (≥20) ACUITY-HORIZONS score (2.4% vs. 5.3%, p = 0.03). Conclusions: In patients with acute MI receiving DES, GRACE and ACUITY-HORIZONS scores may help guide DAPT. In patients with high GRACE score, a more potent P2Y12 blocker may be considered, particularly in the subset not at very high risk of bleeding.

AB - Background: Dual antiplatelet therapy (DAPT) is recommended in patients receiving drug-eluting stents (DES). However, bleeding risk should be weighed against ischemic risk. Utility of GRACE risk score and ACUITY-HORIZONS bleeding risk score was assessed in patients with acute myocardial infarction (MI) according to use of P2Y12 blocker. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health database, 7791 patients with acute MI receiving DES were divided into ticagrelor (n = 1554) and clopidogrel (n = 6237) groups. Propensity-matched 12-month mortality and bleeding event rates were compared according to GRACE and ACUITY-HORIZONS scores. Patients who received thrombolysis, prasugrel or anticoagulants, or who discontinued or switched DAPT were excluded. Results: In all patients, high-risk patients more often received clopidogrel. After propensity score matching (n = 1553 in each group), 12-month mortality was not different, but TIMI major bleeding rate was higher with ticagrelor (2.8% vs. 1.4%, p = 0.007). On subgroup analysis, 12-month mortality was lower with ticagrelor in patients with high (>140) compared to low-to-moderate risk GRACE score (5.1% vs. 7.9%, p = 0.04). When combined with ACUITY-HORIZONS bleeding score, 12-month mortality was lower with ticagrelor in patients with high GRACE score but without very high (≥20) ACUITY-HORIZONS score (2.4% vs. 5.3%, p = 0.03). Conclusions: In patients with acute MI receiving DES, GRACE and ACUITY-HORIZONS scores may help guide DAPT. In patients with high GRACE score, a more potent P2Y12 blocker may be considered, particularly in the subset not at very high risk of bleeding.

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UR - http://www.scopus.com/inward/citedby.url?scp=85046806269&partnerID=8YFLogxK

U2 - 10.1016/j.jjcc.2018.04.006

DO - 10.1016/j.jjcc.2018.04.006

M3 - Article

C2 - 29764713

AN - SCOPUS:85046806269

VL - 72

SP - 411

EP - 419

JO - Journal of Cardiology

JF - Journal of Cardiology

SN - 0914-5087

IS - 5

ER -