Emil L Fosbøl1, Christine Ju2, Kevin J Anstrom2, Marjorie E Zettler2, John C Messenger2, Ron Waksman2, Mark B Effron2, Brian A Baker2, David J Cohen2, Eric D Peterson2, Tracy Y Wang2. 1. From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.). emil.fosbol@dm.duke.edu elf@heart.dk. 2. From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
Abstract
BACKGROUND: Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice. METHODS AND RESULTS: We examined 11 858 acute myocardial infarction patients treated with percutaneous coronary intervention discharged alive on ADPri therapy from 233 United States TRANSLATE-ACS study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) participating hospitals to determine the prevalence of early ADPri cessation (within 1 year), patient-reported reasons for cessation, and associated risk of major adverse cardiovascular events at 1 year. Overall, 2514 (21.2%) of percutaneous coronary intervention-treated patients stopped ADPri by 1 year postmyocardial infarction; the median time from discharge to cessation was 200.5 days (25th, 75th percentiles: 71, 340). Among those with early ADPri cessation, 53.9% received drug-eluting stents and had a median duration of 301 treatment days (25th, 75th percentiles: 137, 353); 33.3% of drug-eluting stent patients stopped treatment within 6 months compared with 64.2% of bare metal stent patients. Those discharged on prasugrel (versus clopidogrel) had a slightly higher likelihood of early ADPri cessation (23.2% versus 21.0%; P=0.03; adjusted hazard ratio, 1.28; 95% confidence interval, 1.17-1.40). Patient-reported reasons for early ADPri cessation included physician-recommended discontinuation (54%), as well as patient self-discontinuation, because of cost (19%), medication side effects (9%), and procedural interruption (10%). Using a time-dependent covariate model, early cessation of ADPri therapy was associated with increased major adverse cardiovascular event (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19-1.65; P<0.0001). CONCLUSIONS: One in 5 percutaneous coronary intervention-treated myocardial infarction patients stopped ADPri treatment within 1 year. Early cessation was associated with increased major adverse cardiovascular event risk. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
BACKGROUND: Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice. METHODS AND RESULTS: We examined 11 858 acute myocardial infarctionpatients treated with percutaneous coronary intervention discharged alive on ADPri therapy from 233 United States TRANSLATE-ACS study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) participating hospitals to determine the prevalence of early ADPri cessation (within 1 year), patient-reported reasons for cessation, and associated risk of major adverse cardiovascular events at 1 year. Overall, 2514 (21.2%) of percutaneous coronary intervention-treated patients stopped ADPri by 1 year postmyocardial infarction; the median time from discharge to cessation was 200.5 days (25th, 75th percentiles: 71, 340). Among those with early ADPri cessation, 53.9% received drug-eluting stents and had a median duration of 301 treatment days (25th, 75th percentiles: 137, 353); 33.3% of drug-eluting stent patients stopped treatment within 6 months compared with 64.2% of bare metal stent patients. Those discharged on prasugrel (versus clopidogrel) had a slightly higher likelihood of early ADPri cessation (23.2% versus 21.0%; P=0.03; adjusted hazard ratio, 1.28; 95% confidence interval, 1.17-1.40). Patient-reported reasons for early ADPri cessation included physician-recommended discontinuation (54%), as well as patient self-discontinuation, because of cost (19%), medication side effects (9%), and procedural interruption (10%). Using a time-dependent covariate model, early cessation of ADPri therapy was associated with increased major adverse cardiovascular event (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19-1.65; P<0.0001). CONCLUSIONS: One in 5 percutaneous coronary intervention-treated myocardial infarctionpatients stopped ADPri treatment within 1 year. Early cessation was associated with increased major adverse cardiovascular event risk. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
Authors: Elias J Dayoub; Matthew Seigerman; Sony Tuteja; Taisei Kobayashi; Daniel M Kolansky; Jay Giri; Peter W Groeneveld Journal: JAMA Intern Med Date: 2018-07-01 Impact factor: 21.873
Authors: Alexander C Fanaroff; Lisa A Kaltenbach; Eric D Peterson; Mohammed W Akhter; Mark B Effron; Timothy D Henry; Tracy Y Wang Journal: J Am Heart Assoc Date: 2018-02-08 Impact factor: 5.501
Authors: Konstantinos C Koskinas; Thomas Zanchin; Roland Klingenberg; Baris Gencer; Fabrice Temperli; Andreas Baumbach; Marco Roffi; Aris Moschovitis; Oliver Muller; David Tüller; Stefan Stortecky; Francois Mach; Thomas F Lüscher; Christian M Matter; Thomas Pilgrim; Dik Heg; Stephan Windecker; Lorenz Räber Journal: J Am Heart Assoc Date: 2018-04-13 Impact factor: 5.501