Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain)
Por:
Ribera, A, Ferreira-Gonzalez, I, Marsal, JR, Oristrell, G, Faixedas, MT, Rosas, A, Tizon-Marcos, H, Rojas, S, Labata, C, Cardenas, M, Homs, S, Tomas-Querol, C, Garcia-Picart, J, Gomez-Hospital, JA, Pijoan, JI, Masotti, M, Mauri, J, Dorado, DG, Carvajal, C, Martinez, P, Lidon, RM, Baneras, J, Garcia-Picart, J, Massotti, M, Jimenez, G, Hernandez, M, Regueiro, A, Basaganyas, J, Loma, P, Cardenas, M, Badosa, E, Fageda, A, Ariza, A, Garcia-Amigo, C, Cequier, A, Marin, G, Maristany, J, Montoya, V, Labata, C, Mauri, J, Fernandez-Nofrerias, E, Carrillo, X, Garcia-Garcia, C, Oliete, C, Bardaji, A, Bonet-Pineda, G, Rojas, S, Munoz, JF, Padilla, F, Homs, S, Baquerizo, B, Recasens, L, Tizon-Marcos, H, Gaya, AB, Worner, F, Barta, L, Agusti, M, Gene, A, Jimenez, X, Mora, A, Faixedas, MT, Jimenez, J and Rosas, A
Publicada:
1 ago 2019
Ahead of Print:
23 jul 2019
Categoría:
Medicine (miscellaneous)
Resumen:
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.
Filiaciones:
Ribera, A:
Univ Autonoma Barcelona, Vall dHebron Univ Hosp & Res Inst, Cardiol Dept, Barcelona, Spain
Spanish Hlth Inst ISCIII, Ctr Invest Biomed Red Epidemiol & Salud Publ CIBE, Madrid, Spain
Ferreira-Gonzalez, I:
Univ Autonoma Barcelona, Vall dHebron Univ Hosp & Res Inst, Cardiol Dept, Barcelona, Spain
Spanish Hlth Inst ISCIII, Ctr Invest Biomed Red Epidemiol & Salud Publ CIBE, Madrid, Spain
Marsal, JR:
Univ Autonoma Barcelona, Vall dHebron Univ Hosp & Res Inst, Cardiol Dept, Barcelona, Spain
Spanish Hlth Inst ISCIII, Ctr Invest Biomed Red Epidemiol & Salud Publ CIBE, Madrid, Spain
Oristrell, G:
Univ Autonoma Barcelona, Vall dHebron Univ Hosp & Res Inst, Cardiol Dept, Barcelona, Spain
Spanish Hlth Inst ISCIII, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Faixedas, MT:
Generalitat Catalunya, Serv Catala Salut, Barcelona, Spain
Rosas, A:
Generalitat Catalunya, Dept Salut, Barcelona, Spain
Generalitat Catalunya, Hlth Dept, Barcelona, Spain
Tizon-Marcos, H:
Univ Autonoma Barcelona, Cardiol Dept, Hosp del Mar, Barcelona, Spain
Univ Autonoma Barcelona, Heart Dis Biomed Res Grp, Barcelona, Spain
Univ Autonoma Barcelona, IMIM Hosp del Mar Med Res Inst, Fac Med, Barcelona, Spain
Hosp del Mar, IMAS, Barcelona, Spain
Rojas, S:
Univ Rovira Virgili, Hosp Univ Tarragona Joan XXIII, IISPV, Cardiol Dept, Tarragona, Spain
Hosp Joan 23, Tarragona, Spain
Labata, C:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Cardenas, M:
Hosp Josep Trueta, Cardiol Dept, Girona, Spain
Hosp Josep Trueta, Girona, Spain
Homs, S:
Hosp Mutua Terrassa, Cardiol Dept, Barcelona, Spain
Hosp Mutua Terrassa, Terrassa, Spain
Tomas-Querol, C:
Hosp Arnau Vilanova, Cardiol Dept, Lleida, Spain
Garcia-Picart, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gomez-Hospital, JA:
Hosp Bellvitge Princeps Espanya, Cardiol Dept, Barcelona, Spain
Pijoan, JI:
Hosp Univ Cruces, Biocruces Bizkaia Hlth Res Inst, Clin Epidemiol Unit, Bilbao, Spain
Spanish Hlth Inst ISCIII, Ctr Invest Biomed Red Epidemiol & Salud Publ CIBE, Madrid, Spain
Masotti, M:
Hosp Clin Barcelona, ICCV, Barcelona, Spain
:
Generalitat Catalunya, Dept Salut, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Dorado, DG:
Univ Autonoma Barcelona, Vall dHebron Univ Hosp & Res Inst, Cardiol Dept, Barcelona, Spain
Spanish Hlth Inst ISCIII, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Carvajal, C:
Hosp Univ Vall dHebron, Barcelona, Spain
Martinez, P:
Hosp Univ Vall dHebron, Barcelona, Spain
Lidon, RM:
Hosp Univ Vall dHebron, Barcelona, Spain
Baneras, J:
Hosp Univ Vall dHebron, Barcelona, Spain
Garcia-Picart, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Massotti, M:
Hosp Clin Barcelona, Barcelona, Spain
Jimenez, G:
Hosp Clin Barcelona, Barcelona, Spain
Hernandez, M:
Hosp Clin Barcelona, Barcelona, Spain
Regueiro, A:
Hosp Clin Barcelona, Barcelona, Spain
Basaganyas, J:
Hosp Josep Trueta, Girona, Spain
Loma, P:
Hosp Josep Trueta, Girona, Spain
Cardenas, M:
Hosp Josep Trueta, Cardiol Dept, Girona, Spain
Hosp Josep Trueta, Girona, Spain
Badosa, E:
Hosp Josep Trueta, Girona, Spain
Fageda, A:
Hosp Josep Trueta, Girona, Spain
Ariza, A:
A Gomez Hosp, Avissawella, Sri Lanka
Garcia-Amigo, C:
A Gomez Hosp, Avissawella, Sri Lanka
Cequier, A:
A Gomez Hosp, Avissawella, Sri Lanka
Marin, G:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Maristany, J:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Montoya, V:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Labata, C:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Mauri, J:
Generalitat Catalunya, Dept Salut, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Oliete, C:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Bardaji, A:
Hosp Joan 23, Tarragona, Spain
Bonet-Pineda, G:
Hosp Joan 23, Tarragona, Spain
Rojas, S:
Univ Rovira Virgili, Hosp Univ Tarragona Joan XXIII, IISPV, Cardiol Dept, Tarragona, Spain
Hosp Joan 23, Tarragona, Spain
Munoz, JF:
Hosp Mutua Terrassa, Terrassa, Spain
Padilla, F:
Hosp Mutua Terrassa, Terrassa, Spain
Homs, S:
Hosp Mutua Terrassa, Cardiol Dept, Barcelona, Spain
Hosp Mutua Terrassa, Terrassa, Spain
Baquerizo, B:
Hosp del Mar, IMAS, Barcelona, Spain
Recasens, L:
Hosp del Mar, IMAS, Barcelona, Spain
Tizon-Marcos, H:
Univ Autonoma Barcelona, Cardiol Dept, Hosp del Mar, Barcelona, Spain
Univ Autonoma Barcelona, Heart Dis Biomed Res Grp, Barcelona, Spain
Univ Autonoma Barcelona, IMIM Hosp del Mar Med Res Inst, Fac Med, Barcelona, Spain
Hosp del Mar, IMAS, Barcelona, Spain
Gaya, AB:
Hosp Arnau Vilanova, Lleida, Spain
Worner, F:
Hosp Arnau Vilanova, Lleida, Spain
Barta, L:
Hosp Arnau Vilanova, Lleida, Spain
Agusti, M:
Hosp Arnau Vilanova, Lleida, Spain
Gene, A:
Hosp Arnau Vilanova, Lleida, Spain
Jimenez, X:
Sistema Emergencies Med SEM SA, Barcelona, Spain
Mora, A:
Sistema Emergencies Med SEM SA, Barcelona, Spain
Faixedas, MT:
Generalitat Catalunya, Hlth Dept, Barcelona, Spain
Jimenez, J:
Generalitat Catalunya, Hlth Dept, Barcelona, Spain
Rosas, A:
Generalitat Catalunya, Dept Salut, Barcelona, Spain
Generalitat Catalunya, Hlth Dept, Barcelona, Spain
Green Published, gold
|