Background: Optimal intensity is unclear for P2Y₁₂receptor blocker therapy after percutaneous coronary intervention (PCI) in real-world clinical practice.

Methods and Results: From the CREDO-Kyoto Registry, the current study population consisted of 25,419 patients (Cohort-2: n=12,161 and Cohort-3: n=13,258) who underwent their first PCI. P2Y₁₂receptor blocker therapies were reduced dose of ticlopidine (200 mg/day), and global dose of clopidogrel (75 mg/day) in 87.7% and 94.8% of patients in Cohort-2 and Cohort-3, respectively. Cumulative 3-year incidence of GUSTO moderate/severe bleeding was significantly higher in Cohort-3 than in Cohort-2 (12.1% and 9.0%, P<0.0001). After adjusting 17 demographic factors and 9 management factors potentially related to the bleeding events other than the type of P2Y₁₂receptor blocker, the higher bleeding risk in Cohort-3 relative to Cohort-2 remained significant (hazard ratio (HR): 1.52 95% confidence interval (CI) 1.37–1.68, P<0.0001). Cohort-3 compared with Cohort-2 was not associated with lower adjusted risk for myocardial infarction/ischemic stroke (HR: 0.96, 95% CI: 0.87–1.06, P=0.44).

Conclusions: In this historical comparative study, Cohort-3 compared with Cohort-2 was associated with excess bleeding risk, which might be at least partly explained by the difference in P2Y₁₂receptor blockers.

背景：在实际临床实践中，经皮冠状动脉介入治疗 (PCI) 后_{P2Y 12}受体阻滞剂治疗的最佳强度尚不清楚

方法和结果：根据 CREDO-Kyoto Registry，目前的研究人群包括 25,419 名接受首次 PCI 的患者（Cohort-2：n=12,161 和 Cohort-3：n=13,258）。在 Cohort-2 和 Cohort-3 中， P2Y ₁₂受体阻滞剂治疗分别为 87.7% 和 94.8% 的患者减少噻氯匹定剂量（200 mg/天）和氯吡格雷全局剂量（75 mg/天）。Cohort-3 中 GUSTO 中/重度出血的累积 3 年发生率显着高于 Cohort-2（12.1% 和 9.0%，P<0.0001）。在调整 17 个人口统计学因素和 9 个可能与除 P2Y 类型以外的出血事件相关的管理因素后₁₂受体阻滞剂，相对于 Cohort-2，Cohort-3 中较高的出血风险仍然显着（风险比（HR）：1.52 95% 置信区间（CI）1.37-1.68，P<0.0001）。与 Cohort-2 相比，Cohort-3 与较低的心肌梗死/缺血性卒中调整风险无关（HR：0.96，95% CI：0.87-1.06，P=0.44）。

结论：在这项历史比较研究中，与 Cohort-2 相比，Cohort-3 与过度出血风险相关，这可能至少部分由 P2Y ₁₂受体阻滞剂的差异来解释。