2020 Korean Society of Myocardial Infarction Expert Consensus Document on Pharmacotherapy for Acute Myocardial Infarction

Abstract

Clinical practice guidelines published by the European Society of Cardiology and the American College of Cardiology/American Heart Association summarize the available evidence and provide recommendations for health professionals to enable appropriate clinical decisions and improve clinical outcomes for patients with acute myocardial infarction (AMI). However, most current guidelines are based on studies in non-Asian populations in the pre-percutaneous coronary intervention (PCI) era. The Korea Acute Myocardial Infarction Registry is the first nationwide registry to document many aspects of AMI from baseline characteristics to treatment strategies. There are well-organized ongoing and published randomized control trials especially for antiplatelet therapy among Korean patients with AMI. Here, members of the Task Force of the Korean Society of Myocardial Infarction review recent published studies during the current PCI era, and have summarized the expert consensus for the pharmacotherapy of AMI.

Effects of Monotherapy with Clopidogrel vs. Aspirin on Vascular Function and Hemostatic Measurements in Patients with Coronary Artery Disease: The Prospective, Crossover I-LOVE-MONO Trial

“…Among East Asian patients presented with ACS, long-term use (over 1 year) of standard-dose potent P2Y 12 inhibitor (e.g., 10 mg of prasugrel and 60 mg of ticagrelor) in addition to aspirin has shown to increase the risk of major bleeding without reducing the risk of ischemic events compared to clopidogrel treatment [ 25 ]. It remains uncertain which P2Y 12 inhibitor monotherapy following DAPT would be the best option for a long-term strategy for secondary prevention in East Asian patients with a moderate-to-high risk profile.…”

Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: a Pandora Box to Explain Prognostic Differences

“…prasugrel, ticagrelor) showed increased bleeding risk and limited anti-ischemic benefit compared with clopidogrel in East Asian patients with ACS. 85) 86) 87) A large-scale RCT 88) and consensus documents 5) 77) suggested the clinical benefit of reduced-dose prasugrel and ticagrelor in East Asian patients presenting with ACS.…”

“…The unusually low incidence and mortality associated with CVD in East Asians is important, since the dosage and strategy for cardiovascular (CV) therapies in the American and European guidelines were based on clinical evidence collected from a Western population. 5) Differences in traditional CV risk factors may not completely account for this racial disparity, nor do known ethnic variations in environmental risk factors. These special phenomena are constantly observed, even in individuals of different ethnicities living within the same geographical location.…”

Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium

“… 4 6 7 8 However, consensus documents by expert groups recommend different strategies in selecting a DAPT regimen for East Asian patients. 9 10 …”