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

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)<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.

Keywords

acute coronary syndromes / adherence to secondary prevention medications / clinical outcome

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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.

Compliance with ethics guidelines

Yang Sun, Chenze Li, Lina Zhang, Dong Hu, Xudong Zhang, Ting Yu, Min Tao, Dao Wen Wang, and Xiaoqing Shen declare that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s11684-017-0502-2 and is accessible for authorized users.

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