Author + information
- Jehangir Din,
- Christian Janssen,
- Simon D. Robinson,
- Reginald Smith,
- Ronald Carere,
- W. Peter Klinke,
- J. David Hilton,
- Anthony Della Siega and
- Nicholas Cruden
Non-adherence with clopidogrel after coronary stenting may be associated with an adverse outcome. We analysed province-wide data to establish if non-adherence with clopidogrel was associated with death or MI.
We linked provincial registries to determine clopidogrel use and outcomes for patients receiving a coronary stent in British Columbia (2004-2006). Non-adherence was defined as not filling a clopidogrel prescription for 5 or more days in 12 months post drug-eluting stents (DES) or 1 month post bare-metal stent (BMS). A cox proportional hazard regression model was used to estimate hazard ratios for clopidogrel non-adherence on outcomes. Follow-up was 4 years.
A total of 15,629 patients received a coronary stent (3,599 DES, 12,030 BMS). Clopidogrel non-adherence within 12 months post-DES was associated with increased mortality (HR 1.95; 95%CI 1.47-2.58), MI (HR 1.4; 95% CI 1.1-1.81), and death or MI (HR 1.58; 95%CI 1.29-1.92). Clopidogrel non-adherence within 1 month post-BMS was associated with increased mortality (HR 1.66; 95%CI 1.24-2.21), and death or MI (HR 1.43; 95%CI 1.11-1.85).
Non-adherence with clopidogrel after coronary stenting is associated with increased death and MI. This is the largest study to date investigating the effect of clopidogrel non-adherence on clinical outcomes. It highlights the need for i) research to understand reasons for non-adherence, and ii) strategies to improve clopidogrel adherence after coronary stenting.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: PCI: Outcomes, Adherence and Appropriateness
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1288-97
- 2013 American College of Cardiology Foundation