title: Identifying patients at risk for premature discontinuation of thienopyridine after coronary stent implantation.
abstract: 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 information (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 the 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.
authors.affiliation: University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Alexandre S
authors.initials: AS
authors.lastname: Quadros
authors.forename: Dulce I
authors.initials: DI
authors.lastname: Welter
authors.forename: Fernanda O
authors.initials: FO
authors.lastname: Camozzatto
authors.forename: Aurea
authors.initials: A
authors.lastname: Chaves
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Gottschall
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D010349:Patient Compliance; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents; D011795:Surveys and Questionnaires; D016312:Treatment Refusal
chemical_list: D011725:Pyridines; C446540:thienopyridine