Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome : a population-based cohort study in Catalonia (Spain)
Ribera, A (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ferreira-Gonzalez, Ignacio (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Marsal, J. R. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Oristrell, G (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Faixedas, M. T. (Servei Català de la Salut)
Rosas, A. (Generalitat de Catalunya. Departament de Salut)
Tizón-Marcos, H. (Universitat Autònoma de Barcelona. Facultat de Medicina)
Rojas, S. (Hospital Universitari Joan XXIII de Tarragona)
Labata, Carlos (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Cardenas, M. (Hospital Universitari de Girona Doctor Josep Trueta)
Homs, S. (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Tomas-Querol, C. (Hospital Arnau de Vilanova (Lleida, Catalunya))
García-Picart, Juan (Institut d'Investigació Biomèdica Sant Pau)
Gómez-Hospital, Joan Antoni (Hospital Universitari de Bellvitge)
Pijoan, J. I. (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Masotti, Monica (Hospital Clínic i Provincial de Barcelona)
Mauri, J. (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
García Dorado, D.. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Ajuts:	Instituto de Salud Carlos III PI13-00399
Nota:	Altres ajuts: Funding The study was supported by the Fundació la Marató de TV3 grand number 430/U/2015.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	ST-elevation myocardial infarction ; Dual antiplatelet therapy ; Percutaneous coronary intervention ; Persistence with treatment
Publicat a:	BMJ open, Vol. 9 Núm. 7 (2019) , p. e028114, ISSN 2044-6055

DOI: 10.1136/bmjopen-2018-028114
PMID: 31340964

10 p, 653.5 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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