Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute
Aida Ribera1,2, Ignacio Ferreira-Gonzalez1,2, Josep Ramon Marsal1,2
1Cardiology Department, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Dual antiplatelet therapy (DAPT) persistence increased after 2012 guidelines for ST-elevation acute coronary syndrome (STEACS) patients. A 12-month DAPT recommendation at discharge significantly improved adherence.
Area of Science:
- Cardiology
- Clinical Pharmacy
- Health Services Research
Background:
- Guidelines in 2012 recommended 12-month dual antiplatelet therapy (DAPT) for ST-elevation acute coronary syndrome (STEACS) patients post-percutaneous coronary intervention (PCI).
- Understanding the impact of these guidelines on DAPT persistence is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the trend in 12-month DAPT persistence from 2010-2015 following guideline implementation.
- To evaluate the association between discharge DAPT recommendations and patient persistence.
Main Methods:
- An observational study utilizing region-wide registry and pharmacy billing data.
- Mixed-effects logistic regression models analyzed 10,711 STEACS patients undergoing PCI between 2010 and 2015.
Main Results:
- 12-month DAPT persistence rose from 58% in 2010 to 73% in 2015.
- Persistence significantly increased one year post-guideline publication (OR=1.20).
- A 12-month DAPT recommendation at discharge strongly correlated with persistence (OR=5.76).
Conclusions:
- 12-month DAPT persistence improved post-guideline implementation.
- Guideline-based discharge recommendations are key drivers of DAPT adherence.
- Standardizing prescribing criteria across hospitals can reduce variability and improve adherence.
Objectives:
Guidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the influence of guideline implementation on the trend in 12-month persistence with DAPT between 2010 and 2015 and to evaluate its relationship with DAPT duration regimens recommended at discharge from PCI hospitals.
Design:
Observational study based on region-wide registry data linked to pharmacy billing data for DAPT follow-up.
Setting:
All PCI hospitals (10) belonging to the acute myocardial infarction (AMI) code network in Catalonia (Spain).
Participants:
10 711 STEACS patients undergoing PCI between 2010 and 2015 were followed up.
Primary And Secondary Outcome Measures:
Primary outcome was 12-month persistence with DAPT. Calendar year quarter, publication of guidelines, DAPT duration regimen recommended in the hospital discharge report, baseline patient characteristics and significant interactions were included in mixed-effects logistic regression based interrupted time-series models.
Results:
The proportion of patients on-DAPT at 12 months increased from 58% (56-60) in 2010 to 73% (71-75) in 2015. The rate of 12-month persistence with DAPT significantly increased after the publication of clinical guidelines with a time lag of 1 year (OR=1.20; 95% CI 1.11 to 1.30). A higher risk profile, more extensive and complex coronary disease, use of drug-eluting stents (OR=1.90; 95% CI 1.50 to 2.40) and a 12-month DAPT regimen recommendation at discharge from the PCI hospital (OR=5.76; 95% CI 3.26 to 10.2) were associated with 12-month persistence.
Conclusion:
Persistence with 12-month DAPT has increased since publication of clinical guidelines. Even though most patients were discharged on DAPT, only 73% with potential indication were on-DAPT 12 months after PCI. A guideline-based recommendation at PCI hospital discharge was highly associated with full persistence with DAPT. Establishing evidence-based, common prescribing criteria across hospitals in the AMI-network would favour adherence and reduce variability.
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