Background We aimed to analyse initiation of and persistence with P2Y12 inhibitors after first-time myocardial infarction (MI). Methods and results Using Danish nationwide registries, we identified patients ≥30 years with first-time MI during 1 January 2005–30 June 2016 and subsequent prescriptions of P2Y12 inhibitors. Independent factors related to initiation of and persistence with P2Y12 inhibitors were analysed by multivariable logistic regression and a Cox proportional hazards model. Patients were stratified by revascularization strategy: percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical therapy alone (MTA). Overall, 79 597 MI patients were included with 39 172 undergoing PCI, 2619 CABG, and 16 640 MTA, showing initiation of P2Y12 inhibitors of 93.4%, 49.0%, and 51.5%, respectively. Congestive heart failure, cerebrovascular disease, cardiac dysrhythmias, renal failure, previous bleeding, and oral anticoagulants were associated with less initiation of P2Y12 inhibitors. Female sex was associated with less initiation of P2Y12 inhibitors following MTA. MTA, coronary angiography, cerebrovascular disease, diabetes with complications, previous bleeding, antidiabetics, and ticagrelor as P2Y12 inhibitor were associated with non-persistence, whereas female sex, advanced age, and concomitant pharmacotherapy with angiotensin-converting enzyme inhibitors, beta-blockers, statins, oral anticoagulants, and aspirin were associated with high persistence. Conclusion Initiation of P2Y12 inhibitors in PCI-treated MI patients was high in contrast to those treated with CABG or MTA and patients with certain comorbidities. Further studies on the benefit–risk ratio of P2Y12 inhibitors in CABG-treated or MTA-treated patients and patients with comorbidities after first-time MI are warranted, as is focus on persistence among patients receiving MTA, patients with comorbidities, and users of ticagrelor.

中文翻译：

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根据血运重建策略在心肌梗死患者中启动和持续使用 P2Y12 抑制剂：一项全国性研究

背景 我们旨在分析首次心肌梗死 (MI) 后 P2Y12 抑制剂的启动和持续使用情况。方法和结果 使用丹麦全国登记处，我们确定了 2005 年 1 月 1 日至 2016 年 6 月 30 日期间≥30 岁首次 MI 和随后开具 P2Y12 抑制剂处方的患者。通过多变量逻辑回归和 Cox 比例风险模型分析与 P2Y12 抑制剂的开始和持续性相关的独立因素。根据血运重建策略对患者进行分层：经皮冠状动脉介入治疗 (PCI)、冠状动脉旁路移植术 (CABG) 或单纯药物治疗 (MTA)。总体而言，79 597 名 MI 患者包括 39 172 名接受 PCI、2 619 名 CABG 和 16 640 名 MTA，显示开始使用 P2Y12 抑制剂的比例分别为 93.4%、49.0% 和 51.5%。充血性心力衰竭、脑血管疾病、心律失常、肾功能衰竭、既往出血和口服抗凝剂与较少开始使用 P2Y12 抑制剂相关。女性与 MTA 后较少使用 P2Y12 抑制剂有关。MTA、冠状动脉造影、脑血管疾病、合并并发症的糖尿病、既往出血、降糖药和替格瑞洛作为 P2Y12 抑制剂与非持久性相关，而女性、高龄和同时使用血管紧张素转换酶抑制剂、β 受体阻滞剂、他汀类药物、口服抗凝剂和阿司匹林与高持久性相关。结论 PCI 治疗的 MI 患者中 P2Y12 抑制剂的启动率高于接受 CABG 或 MTA 治疗的患者和有某些合并症的患者。