Delay in Filling First Clopidogrel Prescription After Coronary Stenting Is Associated With an Increased Risk of Death and Myocardial Infarction
| Autor: | Christian Janssen, Reginald Smith, J. David Hilton, W. Peter Klinke, Ron G. Carere, Nicholas L. Cruden, Simon D. Robinson, Anthony Della Siega, Jehangir Din |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Ticlopidine Time Factors medicine.medical_treatment Myocardial Infarction Medication Adherence Risk Factors Interquartile range death Internal medicine Coronary stent medicine Humans Myocardial infarction Original Research Aged Proportional Hazards Models clopidogrel business.industry percutaneous coronary intervention Hazard ratio Stent Percutaneous coronary intervention Drug-Eluting Stents Middle Aged Clopidogrel medicine.disease Interventional Cardiology Treatment Outcome Cardiology Platelet aggregation inhibitor Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| DOI: | 10.1161/jaha.113.000669 |
| Popis: | Background Patients frequently experience difficulties with medication compliance after hospital discharge. We investigated the effect of a delay in filling a first clopidogrel prescription after hospital discharge on clinical outcomes subsequent to coronary stenting. Methods and Results Hospital administrative, community pharmacy, and cardiac revascularization data were determined for all patients receiving a coronary stent in British Columbia 2004–2006 with follow‐up out to 2 years. Cox's proportional hazard regression analysis, adjusting for baseline demographics and procedural variables, was performed to examine the effects of delay in filling a clopidogrel prescription after hospital discharge on clinical outcomes. Of 15 629 patients treated with coronary stents, 3599 received at least 1 drug‐eluting stent ( DES ), whereas 12 030 received bare metal stents ( BMS ) alone. In total, 1064 (30%) and 3758 (31%) patients in the DES and BMS groups, respectively, failed to fill a prescription within 3 days of discharge (median, 1 day; interquartile range [ IQR], 1 to 3). After regression analysis, a delay of >3 days was predictive of mortality and recurrent myocardial infarction ( MI ) irrespective of stent type ( DES : hazard ratio [ HR], 2.4; 95% confidence interval [ CI], 1.7 to 3.4; and HR, 2.0; 95% CI, 1.5 to 2.7, respectively, and BMS : HR, 2.2; 95% CI, 1.9 to 2.6; and HR, 1.8; 95% CI, 1.5 to 2.1, respectively). This excess hazard was greatest in the 30‐day period immediately after hospital discharge (mortality: HR, 5.5; 95% CI, 3.5 to 8.6; and MI : HR, 3.1; 95% CI, 2.4 to 4.0, for all patients). Conclusions Delays in patients filling their first prescription for clopidogrel after coronary stenting are common and associated with adverse clinical outcomes, irrespective of stent type. Strategies to reduce delays have the potential to improve clinical outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text