title: [Evaluation of a public health programme: direct Clopidogrel administration by cardiology units in acute myocardial infarction].
abstract: OBJECTIVE
  to compare the benefit of a personalised outpatient therapy prescribed upon discharge by the cardiology unit to the patients undergoing a percutaneous coronary intervention with drug-eluting stent or bare-metal stent vs. the usual practice.
  
  
  METHODS
  controlled, multicentre, non-randomized study that enrolled patients who underwent coronary stent implantation and treated in the year after stent implantation with two protocols: the treatment group received Clopidogrel directly from the cardiology unit at each monitoring visit; the control group received a prescription for outpatient treatment through the standard retail pharmacy channel.
  
  
  METHODS
  the recruited centres adopting the new treatment protocol are Magenta, Legnano, and Rho (ASL Milano1, Magenta - Lombardy Region, Northern Italy), with 477 patients included; the recruited centres following for the standard protocol are Niguarda and San Carlo (ASL Milano), with 307 patients included. We identified all patients aged ≥40 years, discharged after coronary stent implantation between January 1st, 2010 and March 31st, 2011, and followed for 1 year.
  
  
  METHODS
  all coronary events, second coronary interventions or deaths in the year after hospital discharge.
  
  
  RESULTS
  we found differences between the two treatments in relation with coronary events: hazard ratio (HR) for the control group in patients with ST-elevation myocardial infarction (STEMI) is 3.32 (95%CI 1.67- 6.62), HR in patients with non-ST elevation myocardial infarction (NSTEMI) is 2.44 (95%CI 1.07-5.57). The compliance at 1 year is 80% in the treated group vs. 70% in the control group, respectively (p-value <0.01).
  
  
  CONCLUSIONS
  the application of the therapeutic plan, governed by the interventional cardiology, increases treatment adherence and reduces the risk of cardiovascular events subsequent to the insertion of a stent. It is crucial, therefore, to improve the adherence to dual antiplatelet therapy by using high levels of integration between inpatient and outpatient care to reduce adverse health outcomes during post-surgery phase and to ensure the taking in charge of the patient.
authors.affiliation: Osservatorio epidemiologico e registri specializzati, ASL Milano1, Magenta (MI).
authors.forename: Anna Giulia
authors.initials: AG
authors.lastname: Pedrazzoli
authors.affiliation: Assistenza specialistica, ASL Milano1, Magenta (MI).
authors.forename: Daniela
authors.initials: D
authors.lastname: Malnis
authors.affiliation: Assistenza farmaceutica, ASL Milano1, Magenta (MI).
authors.forename: Sarah
authors.initials: S
authors.lastname: Cattaneo
authors.affiliation: Unità operative di cardiologia, AO Salvini, Garbagnate Milanese (MI).
authors.forename: Gianni
authors.initials: G
authors.lastname: Rovelli
authors.affiliation: Unità operative di cardiologia, AO Ospedale Civile di Legnano (MI).
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Unità operative di cardiologia, AO Niguarda Ca' Granda, Milano.
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugman
authors.affiliation: Unità operative di cardiologia, AO Ospedale San Carlo Borromeo, Milano.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marzegalli
authors.affiliation: Osservatorio epidemiologico e registri specializzati, ASL Milano1, Magenta (MI). antonio.russo@aslmi1.mi.it.
authors.forename: Antonio Giampiero
authors.initials: AG
authors.lastname: Russo
mesh_terms: D000328:Adult; D002309:Cardiology; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D010045:Outpatients; D010349:Patient Compliance; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011634:Public Health; D012189:Retrospective Studies; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine