Identifying Patients at Risk for Premature Discontinuation of Thienopyridine After Coronary Stent Implantation

• Published in: The American journal of cardiology Vol. 107; no. 5; pp. 685 - 689
• Main Authors: Quadros, Alexandre S., MD, PhD, Welter, Dulce I., RN, MSc, Camozzatto, Fernanda O., MD, Chaves, Áurea, MD, PhD, Mehta, Rajendra H., MD, MS, Gottschall, Carlos A., MD, PhD, Lopes, Renato D., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier; Elsevier Limited
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - surgery; Biological and medical sciences; Brazil - epidemiology; Cardiology; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diseases of mother, fetus and pregnancy; Female; Follow-Up Studies; Graft Occlusion, Vascular - epidemiology; Graft Occlusion, Vascular - etiology; Gynecology. Andrology. Obstetrics; Heart; Humans; Incidence; Male; Medical sciences; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Patient Compliance; Patients; Postoperative Care - methods; Pregnancy. Fetus. Placenta; Prospective Studies; Pyridines - therapeutic use; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Assessment - methods; Risk Factors; Stents; Surveys and Questionnaires; Transplants & implants; Treatment Refusal; Brazil; Human; Premature; Endoprosthesis; Coronary artery; Instrumentation therapy; Cardiovascular disease; Implantation; Patient; Circulatory system; Cardiology; Coronary heart disease; Stent
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.10.045

We sought to identify patients at risk for premature discontinuation of thienopyridines and to develop a risk score for thienopyridine adherence after coronary stent implantation. Patients were prospectively included from December 2007 to March 2008. At 1-month follow-up, all patients were given the Morisky questionnaire and asked if they had stopped taking thienopyridines. Multivariate analysis identified predictors of thienopyridine discontinuation; points were assigned to each variable according to the odds ratios and the c-statistic of the score was calculated. Mean age of the 400 patients included was 61.0 ± 10.4 years; 66 patients (16.5%) stopped thienopyridines after 1 month. Reasons for discontinuation were cost (62%), lack of information (17%), and recommendation by another doctor to stop treatment (15%). Factors associated with discontinuation included unmarried status (odds ratio 2.48, p = 0.046), lack of private health insurance (odds ratio 4.68, p = 0.041), acute coronary syndrome (odds ratio 2.31, p = 0.004), nondiabetics (odds ratio 2.20, p = 0.041), and patients who earned <2 times (odds ratio 8.23, p <0.001) and 2 to 3 times (odds ratio 4.46, p = 0.021) the minimum wage. Total risk score was 0 to 14 points and was strongly associated with thienopyridine discontinuation. For total scores of 0 to 4, 5 to 8, 9 to 12, and ≥13, 0%, 7%, 20%, and 37% of patients, respectively, stopped thienopyridines (c-statistic 0.76, p <0.0001). Risk score was also significantly associated with complete adherence as assessed by the Morisky questionnaire (c-statistic 0.74, p <0.001). In conclusion, we have identified patients at risk for premature discontinuation of thienopyridines using variables obtained before stent implantation and developed a risk score that accurately predicts premature thienopyridine discontinuation.