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

doi:10.1007/s11684-017-0502-2

Front. Med.

2017, Vol. 11

Issue (1) : 53-61 https://doi.org/10.1007/s11684-017-0502-2

RESEARCH ARTICLE

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

Yang Sun,Chenze Li,Lina Zhang,Dong Hu,Xudong Zhang,Ting Yu,Min Tao,Dao Wen Wang(

),Xiaoqing Shen(

)

Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

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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

Corresponding Author(s): Dao Wen Wang,Xiaoqing Shen

Just Accepted Date: 28 December 2016 Online First Date: 17 February 2017 Issue Date: 20 March 2017

Cite this article:

Yang Sun,Chenze Li,Lina Zhang, et al. Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients[J]. Front. Med., 2017, 11(1): 53-61.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0502-2
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I1/53

Fig.1 Flowchart of study cohort identification and exclusion. ACS, acute coronary syndrome.

Tab.1 Baseline characteristics of the study population

Characteristics	ACS population			PCI population
Characteristics	High adherence	Low adherence	P value	High adherence	Low adherence	P value
Age (year)	59.26±10.217	57.86±10.824	0.197	58.90±10.192	61.32±10.468	0.15
Gender			0.972			0.873
Male, n (%)	1265 (74.6%)	70 (74.5%)		1121 (75.2%)	29 (76.3%)
Female, n (%)	430 (25.4%)	24 (25.5%)		370 (24.8%)	9 (23.7%)
Psychosocial characteristics
Medical insurance types			0.43			0.747
Urban workers medical insurance, n (%)	264 (24.3%)	9 (15.0%)		240 (24.9%)	4 (15.4%)
Urban residents medical insurance, n (%)	407 (37.4%)	27 (45.0%)		361 (37.5%)	12 (46.2%)
NCMS, n (%)	283 (26.0%)	15 (25.0%)		244 (25.4%)	7 (26.9%)
Free medicare, n (%)	5 (0.5%)	0 (0%)		5 (0.5%)	0 (0.0%)
No medical insurance	129 (11.9%)	9 (15.0%)		112 (11.6%)	3 (11.5%)
Education level			0.586			0.079
Low education level, n (%)	316 (26.1%)	18 (28.1%)		275 (25.2%)	11 (39.3%)
Medium education level, n (%)	703 (58.1%)	39 (60.9%)		642 (58.7%)	16 (57.1%)
High education level, n (%)	190 (15.7%)	7 (10.9%)		176 (16.1%)	1 (3.6%)
ACS types			0.79			0.293
STEMI, n (%)	348 (20.5%)	18 (19.1%)		323 (21.7%)	12 (31.6%)
Non-STEMI, n (%)	240 (14.2%)	15 (16.0%)		215 (14.4%)	6 (15.8%)
UA, n (%)	1107 (65.3%)	61 (64.9%)		953 (63.9%)	20 (52.6%)
ACS treatment			<0.01	?	?
Conservative, n (%)	172 (10.1%)	48 (51.1%)		?	?
PCI only, n (%)	1491 (88.0%)	38 (40.4%)		?	?
CABG only, n (%)	29 (1.7%)	8 (8.5%)		?	?
PCI+ CABG, n (%)	3 (0.2%)	0 (0.0%)		?	?
Comorbid conditions
Hypertension, n (%)	1014 (59.8%)	63 (67.0%)	0.194	878 (58.9%)	27 (71.1%)	0.132
Diabetes mellitus, n (%)	394 (23.2%)	22 (23.4%)	0.972	347 (23.3%)	9 (23.7%)	0.953
Hyperlipemia, n (%)	642 (37.9%)	31 (33.0%)	0.34	596 (40.0%)	17 (44.7%)	0.554
Heart failure, n (%)	354 (20.9%)	20 (21.3%)	0.928	288 (19.3%)	6 (15.8%)	0.586
Atrial fibrillation, n (%)	56 (3.3%)	4 (4.3%)	0.553	49 (3.3%)	3 (7.9%)	0.136
CRD, n (%)	50 (2.9%)	2 (2.1%)	1	34 (2.3%)	1 (2.6%)	0.59
Stroke, n (%)	74 (4.4%)	3 (3.2%)	0.795	62 (4.2%)	3 (7.9%)	0.217
ICD, n (%)	14 (0.8%)	0 (0.0%)	1	11 (0.7%)	0 (0.0%)	1
Radiofrequency ablation, n (%)	5 (0.3%)	1 (1.1%)	0.277	5 (0.3%)	0 (0.0%)	1

Tab.2 Baseline characteristics of the study population according to adherence to P2Y12 antagonists

Tab.3 Low ATM between the groups with MACE vs. without MACE in the study

Fig.2 Estimated rates of MACE per adherence to P2Y12 antagonists in ACS population. The panel shows outcomes of the study population. X-axis presents days after discharge and Y-axis indicates cumulative rates of MACE. The inset graph in each panel shows the same curves on a larger scale. MACE: major adverse cardiac events.

Fig.3 Estimated rates of MACE per adherence to P2Y12 antagonists in PCI population. The panel shows the outcomes for the PCI population. X-axis represents days after discharge, and Y-axis shows cumulative rates of MACE. The inset graph in each panel shows the same curves on a larger scale. MACE: major adverse cardiac events.

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