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Initiation and persistence with clopidogrel treatment after acute myocardial infarction: a nationwide study

Rikke Sørensen1, G H Gislason, E L Fosbøl

  • 1Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. rs@heart.dk

British Journal of Clinical Pharmacology
|October 1, 2008
PubMed

Insights

Clopidogrel initiation and persistence are high for myocardial infarction (MI) patients with percutaneous coronary intervention (PCI). However, significant underuse was observed in MI patients without PCI and those with heart failure.

Area of Science:

  • Cardiology
  • Pharmacotherapy
  • Public Health

Background:

  • Clopidogrel is a crucial antiplatelet medication for myocardial infarction (MI) patients.
  • Understanding treatment patterns is vital for optimizing patient outcomes.
  • Percutaneous coronary intervention (PCI) is a common procedure for MI management.

Purpose of the Study:

  • To analyze the initiation and persistence of clopidogrel treatment in an unselected population of MI patients.
  • To identify potential underuse of clopidogrel in MI patients, with or without PCI.
  • To investigate factors influencing clopidogrel treatment adherence.

Main Methods:

  • Individual-level linkage of nationwide administrative registries in Denmark (2000-2005).
  • Inclusion of patients admitted with first-time MI.
  • Multivariable logistic regression and Cox proportional hazard models to analyze initiation and persistence.

Main Results:

  • Clopidogrel initiation increased significantly from 2000-2005 for MI patients with PCI (80.4% to 93.7%) and without PCI (2.8% to 39.3%).
  • Persistence with 9-month treatment was higher for MI patients with PCI (77.5%) compared to those without PCI (53.9%) in 2004-2005.
  • MI patients with heart failure showed reduced clopidogrel treatment initiation and persistence.

Conclusions:

  • High rates of clopidogrel initiation and persistence are observed in MI patients undergoing PCI.
  • Substantial underuse of clopidogrel exists in MI patients not treated with PCI.
  • MI patients with concomitant heart failure represent a population with significant underuse of clopidogrel therapy.
Abstract

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