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Utilization of P2Y12 Inhibitors in Older Adults With ST-Elevation Myocardial Infarction and Frailty
Ko Darae, Pande Ashvin, Lin Kueiyu Joshua, Cervone Alexander, Bessette Lily G, Lee Su Been, Cheng Susan, Glynn Robert J et al.. The American journal of cardiology, 2023-09-27
Topic: Brain proteins, microglia and lab models
Choosing optimal P2Y12 inhibitor in frail older adults is challenging because they are at increased risk of both ischemic and bleeding events. We conducted a retrospective cohort study of Medicare Advantage Plan beneficiaries who were prescribed clopidogrel, prasugrel, or ticagrelor after percutaneous coronary intervention-treated ST-elevation myocardial infarction from January 1, 2010 to December 31, 2020. Frailty was defined using claims-based frailty index ≥0.25. We conducted multivariable logistic regression to identify factors associated with using potent P2Y12 inhibitors and multivariable-adjusted competing risk analyses to compare the rate of discontinuation of potent P2Y12 inhibitors in frail versus non-frail patients. There were 11,239 patients (mean age 74 years, 39% women). The prevalence of cardiovascular and geriatric co-morbidities was as follows: 32% chronic kidney disease, 28% heart failure, 10% previous myocardial infarction, 6% dementia, 20% anemia, and 12% frailty. The proportion of patients receiving clopidogrel decreased from 78.3% in 2010 to 2013 to 42.1% in 2018 to 2020, with a concurrent increase in those receiving potent P2Y12 inhibitors (mostly ticagrelor) from 21.7% to 57.9%. Frailty was independently associated with reduced odds of initiation (odds ratio 0.78, 95% confidence interval 0.67 to 0.90) but not with discontinuation of potent P2Y12 inhibitors (subdistribution hazard ratio 1.09, 95% confidence interval 0.98 to 1.22). In conclusion, frail older adults are less likely to receive potent P2Y12 inhibitors after percutaneous coronary intervention-treated ST-elevation myocardial infarction, but they are as likely as non-frail patients to continue with the prescribed P2Y12 inhibitor.
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APA 7th
Darae, K., Ashvin, P., Joshua, L. K., Alexander, C., Bessette Lily, G., Been, L. S., et al. (2023). Utilization of P2Y12 Inhibitors in Older Adults With ST-Elevation Myocardial Infarction and Frailty. The American journal of cardiology. https://doi.org/10.1016/j.amjcard.2023.08.059
Vancouver
Darae K, Ashvin P, Joshua LK, Alexander C, Bessette Lily G, Been LS, et al. Utilization of P2Y12 Inhibitors in Older Adults With ST-Elevation Myocardial Infarction and Frailty. The American journal of cardiology. 2023. doi:10.1016/j.amjcard.2023.08.059. PMID: 37757521.
BibTeX
@article{darae2023-37757521,
author = {Darae, Ko and Ashvin, Pande and Joshua, Lin Kueiyu and Alexander, Cervone and Bessette Lily, G. and Been, Lee Su and Susan, Cheng and Glynn Robert, J. and others},
title = {{Utilization of P2Y12 Inhibitors in Older Adults With ST-Elevation Myocardial Infarction and Frailty}},
journal = {The American journal of cardiology},
year = {2023},
doi = {10.1016/j.amjcard.2023.08.059},
pmid = {37757521},
url = {https://doi.org/10.1016/j.amjcard.2023.08.059}
}
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Key findings
- Choosing optimal P2Y12 inhibitor in frail older adults is challenging because they are at increased risk of both ischemic and bleeding events.
- We conducted multivariable logistic regression to identify factors associated with using potent P2Y12 inhibitors and multivariable-adjusted competing risk analyses to compare the rate of discontinuation of potent P2Y12 inhibitors in frail versus non-frail patients.
- Frailty was independently associated with reduced odds of initiation (odds ratio 0.78, 95% confidence interval 0.67 to 0.90) but not with discontinuation of potent P2Y12 inhibitors (subdistribution hazard ratio 1.09, 95% confidence interval 0.98 to 1.22).
- In conclusion, frail older adults are less likely to receive potent P2Y12 inhibitors after percutaneous coronary intervention-treated ST-elevation myocardial infarction, but they are as likely as non-frail patients to continue with the prescribed P2Y12 inhibitor.
Why it matters
This study examined which antiplatelet drugs frail older adults receive after a heart attack and found that frailty was linked to lower odds of getting newer, stronger drugs. It is about heart attack care, not about treating, curing, or preventing Alzheimer's disease.
Study details
- Study designcohort study
- Participants11,239
- Effect size78.3%; 42.1%; 21.7% to 57.9%
- Evidence strengthModerate
How this study scored 57/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (The American journal of cardiology) |
| Journal's citation record | 3 / 4 | The American Journal of Cardiology: journal h-index 352 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 11,239 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 8 times (OpenAlex, 2026-10-17) |
| Citations per year | 1 / 5 | 1.6 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 2 / 6 | Cited 1.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Dae Hyun Kim: h-index 55 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Massachusetts General Hospital: institution h-index 2,053 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 37757521) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 57 / 100 | — |
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