Identifying Patients at Risk for Premature Discontinuation of Thienopyridine After Coronary Stent Implantation
Quadros, Alexandre S.
Welter, Dulce I.
Camozzatto, Fernanda O.
Mehta, Rajendra H.
Gottschall, Carlos A.
Lopes, Renato D. [UNIFESP]
Is part ofAmerican Journal of Cardiology
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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 informatim (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 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. (c) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:685-689)
CitationAmerican Journal of Cardiology. Bridgewater: Excerpta Medica Inc-Elsevier B.V., v. 107, n. 5, p. 685-689, 2011.
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