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Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients

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Abstract

Low adherence to secondary prevention medications (ATM) of patients after acute coronary syndrome (ACS) is associated with poor clinical outcomes. However, literature provides limited data on assessment of ATM and risks associated with poor in Chinese patients with ACS. In the current work, ATM was assessed in consecutively recruited patients with ACS in Tongji Hospital from November 5, 2013 to December 31, 2014. A total of 2126 patients were classified under low adherence (proportion of days covered (PDC) C< 50%) and high adherence (PDC>50%) groups based on their performance after discharge. All patients were followed up at the 1st, 6th, and 12th month of discharge while recording ATM and major adverse cardiac events (MACE). Bivariate logistic regression was used to identify the factors associated with ATM. Cox regression was used to analyze the association between ATM and MACE within one year after discharge. Results showed that coronary artery bypass grafting (CABG) alone had significantly lower proportion of high adherence to P2Y12 antagonists (83.0% vs. 90.7%, P < 0.01) than patients treated with percutaneous coronary intervention (PCI) only. Moreover, in patients undergoing PCI, high adherence to P2Y12 antagonists decreased the risk of MACE (hazard ratio = 0.172, 95% confidence interval: 0.039–0.763; P = 0.021). In conclusion, PCI-treated patients are more prone to remaining adherent to medications than CABG-treated patients. High adherence to P2Y12 antagonists was associated with lower risk of MACE.

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References

  1. Gaziano TA, Opie LH, Weinstein MC. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet 2006; 368(9536): 679–686

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S, Baumgartner H, Gaemperli O, Achenbach S, Agewall S, Badimon L, Baigent C, Bueno H, Bugiardini R, Carerj S, Casselman F, Cuisset T, Erol Ç, Fitzsimons D, Halle M, Hamm C, Hildick-Smith D, Huber K, Iliodromitis E, James S, Lewis BS, Lip GY, Piepoli MF, Richter D, Rosemann T, Sechtem U, Steg PG, Vrints C, Luis Zamorano J; Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37(3): 267–315

    Article  PubMed  CAS  Google Scholar 

  3. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O’Gara PT, Sabatine MS, Smith PK, Smith SC. 2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 68(10): 1082–1115

    Article  PubMed  Google Scholar 

  4. Gislason GH, Rasmussen JN, Abildstrøm SZ, Gadsbøll N, Buch P, Friberg J, Rasmussen S, Køber L, Stender S, Madsen M, Torp-Pedersen C. Long-term compliance with beta-blockers, angiotensinconverting enzyme inhibitors, and statins after acute myocardial infarction. Eur Heart J 2006; 27(10): 1153–1158

    Article  PubMed  CAS  Google Scholar 

  5. Mathews R, Wang TY, Honeycutt E, Henry TD, Zettler M, Chang M, Fonarow GC, Peterson ED; TRANSLATE-ACS Study Investigators. Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study. Am Heart J 2015; 170(1): 62–69

    Article  PubMed  PubMed Central  Google Scholar 

  6. Haukka J, Niskanen L, Partonen T, Lönnqvist J, Tiihonen J. Statin usage and all-cause and disease-specific mortality in a nationwide study. Pharmacoepidemiol Drug Saf 2012; 21(1): 61–69

    Article  PubMed  CAS  Google Scholar 

  7. Ferreira-González I, Marsal JR, Ribera A, Permanyer-Miralda G, García-Del Blanco B, Martí G, Cascant P, Masotti-Centol M, Carrillo X, Mauri J, Batalla N, Larrousse E, Martín E, Serra A, Rumoroso JR, Ruiz-Salmerón R, de la Torre JM, Cequier A, Gómez-Hospital JA, Alfonso F, Martín-Yuste V, Sabatè M, García-Dorado D. Double antiplatelet therapy after drug-eluting stent implantation: risk associated with discontinuation within the first year. J Am Coll Cardiol 2012; 60(15): 1333–1339

    Article  PubMed  CAS  Google Scholar 

  8. Eagle KA, Kline-Rogers E, Goodman SG, Gurfinkel EP, Avezum A, Flather MD, Granger CB, Erickson S, White K, Steg PG. Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med 2004; 117(2): 73–81

    Article  PubMed  Google Scholar 

  9. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW; Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115(17): 2344–2351

    Article  PubMed  Google Scholar 

  10. Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernández-Avilés F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N. Universal definition of myocardial infarction. Circulation 2007; 116(22): 2634–2653

    Article  PubMed  Google Scholar 

  11. Shalansky SJ, Levy AR, Ignaszewski AP. Self-reported Morisky score for identifying nonadherence with cardiovascular medications. Ann Pharmacother 2004; 38(9): 1363–1368

    Article  PubMed  Google Scholar 

  12. Hlatky MA, Solomon MD, Shilane D, Leong TK, Brindis R, Go AS. Use of medications for secondary prevention after coronary bypass surgery compared with percutaneous coronary intervention. J Am Coll Cardiol 2013; 61(3): 295–301

    Article  PubMed  CAS  Google Scholar 

  13. Khanderia U, Townsend KA, Erickson SR, Vlasnik J, Prager RL, Eagle KA. Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes. Ann Pharmacother 2008; 42(2): 192–199

    Article  PubMed  Google Scholar 

  14. Doshi JA, Zhu J, Lee BY, Kimmel SE, Volpp KG. Impact of a prescription copayment increase on lipid-lowering medication adherence in veterans. Circulation 2009; 119(3): 390–397

    Article  PubMed  PubMed Central  Google Scholar 

  15. Taira DA, Wong KS, Frech-Tamas F, Chung RS. Copayment level and compliance with antihypertensive medication: analysis and policy implications for managed care. Am J Manag Care 2006; 12(11): 678–683

    PubMed  Google Scholar 

  16. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23(8): 1296–1310

    Article  PubMed  CAS  Google Scholar 

  17. Melloni C, Alexander KP, Ou FS, La Pointe NM, Roe MT, Newby LK, Baloch K, Ho PM, Rumsfeld JS, Peterson ED. Predictors of early discontinuation of evidence-based medicine after acute coronary syndrome. Am J Cardiol 2009; 104(2): 175–181

    Article  PubMed  Google Scholar 

  18. Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, Messenger JC, Khanal S, Peterson ED, Bach RG, Krumholz HM, Cohen DJ. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation 2006; 113(24): 2803–2809

    Article  PubMed  CAS  Google Scholar 

  19. Airoldi F, Colombo A, Morici N, Latib A, Cosgrave J, Buellesfeld L, Bonizzoni E, Carlino M, Gerckens U, Godino C, Melzi G, Michev I, Montorfano M, Sangiorgi GM, Qasim A, Chieffo A, Briguori C, Grube E. Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment. Circulation 2007; 116(7): 745–754

    Article  PubMed  CAS  Google Scholar 

  20. Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA 2007; 297(2): 177–186

    Article  PubMed  CAS  Google Scholar 

  21. Thim T, Johansen MB, Chisholm GE, Schmidt M, Kaltoft A, Sørensen HT, Thuesen L, Kristensen SD, Bøtker HE, Krusell LR, Lassen JF, Thayssen P, Jensen LO, Tilsted HH, Maeng M. Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study. BMC Cardiovasc Disord 2014; 14(1): 100

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Acknowledgements

We want to acknowledge all the participants in this study, especially Profs. Jiangtao Yan, Jiangang Jiang, Hesong Zeng, and Xiamei Guo for their help in patient recruitment and also Drs. Xiang Nie, Yong Yang, Mengying He, Yuying Li, Qiang Huang, and Zhihui Chen for their contribution on the collection of medical records. This study was supported by grants from the National “973” program (No. 2012CB518004) and the Key Project of National Natural Science Foundation of China (No. 91439203). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Yang Sun, Chenze Li, Lina Zhang, Dong Hu, Xudong Zhang, Ting Yu, Min Tao, Dao Wen Wang & Xiaoqing Shen

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  1. Yang Sun
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  2. Chenze Li
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  3. Lina Zhang
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  4. Dong Hu
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  5. Xudong Zhang
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  6. Ting Yu
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  7. Min Tao
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  8. Dao Wen Wang
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  9. Xiaoqing Shen
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Correspondence to Dao Wen Wang or Xiaoqing Shen.

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Yang Sun and Chenze Li contributed equally to this work.

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Sun, Y., Li, C., Zhang, L. et al. Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients. Front. Med. 11, 53–61 (2017). https://doi.org/10.1007/s11684-017-0502-2

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  • DOI: https://doi.org/10.1007/s11684-017-0502-2

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