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Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients
Yang Sun1, Chenze Li1, Lina Zhang1
1Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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.
Insights
Adherence to secondary prevention medications after acute coronary syndrome (ACS) is crucial. Patients treated with percutaneous coronary intervention (PCI) showed better medication adherence and reduced major adverse cardiac events (MACE) compared to those undergoing coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Low adherence to secondary prevention medications after acute coronary syndrome (ACS) is linked to adverse clinical outcomes.
- Limited data exists on medication adherence and associated risks in Chinese ACS patients.
Purpose of the Study:
- To assess medication adherence in Chinese ACS patients.
- To identify factors associated with adherence and the impact of adherence on major adverse cardiac events (MACE).
Main Methods:
- A cohort of 2126 ACS patients were recruited and categorized by adherence (proportion of days covered [PDC] <50% or >50%).
- Patients were followed up at 1, 6, and 12 months post-discharge, recording adherence and MACE.
- Logistic and Cox regression analyses were used to identify adherence factors and MACE associations.
Main Results:
- Coronary artery bypass grafting (CABG) patients had lower adherence to P2Y12 antagonists (83.0%) compared to percutaneous coronary intervention (PCI) patients (90.7%).
- In PCI patients, high adherence to P2Y12 antagonists significantly reduced MACE risk (HR=0.172, P=0.021).
Conclusions:
- PCI-treated patients demonstrate better medication adherence than CABG-treated patients.
- High adherence to P2Y12 antagonists is associated with a reduced risk of MACE in ACS patients, particularly those treated with PCI.
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