title: Early Cessation of Adenosine Diphosphate Receptor Inhibitors Among Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention: Insights From the TRANSLATE-ACS Study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome).
abstract: Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice.
  
  
  
  We examined 11 858 acute myocardial infarction patients treated with percutaneous coronary intervention discharged alive on ADPri therapy from 233 United States TRANSLATE-ACS study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) participating hospitals to determine the prevalence of early ADPri cessation (within 1 year), patient-reported reasons for cessation, and associated risk of major adverse cardiovascular events at 1 year. Overall, 2514 (21.2%) of percutaneous coronary intervention-treated patients stopped ADPri by 1 year postmyocardial infarction; the median time from discharge to cessation was 200.5 days (25th, 75th percentiles: 71, 340). Among those with early ADPri cessation, 53.9% received drug-eluting stents and had a median duration of 301 treatment days (25th, 75th percentiles: 137, 353); 33.3% of drug-eluting stent patients stopped treatment within 6 months compared with 64.2% of bare metal stent patients. Those discharged on prasugrel (versus clopidogrel) had a slightly higher likelihood of early ADPri cessation (23.2% versus 21.0%; P=0.03; adjusted hazard ratio, 1.28; 95% confidence interval, 1.17-1.40). Patient-reported reasons for early ADPri cessation included physician-recommended discontinuation (54%), as well as patient self-discontinuation, because of cost (19%), medication side effects (9%), and procedural interruption (10%). Using a time-dependent covariate model, early cessation of ADPri therapy was associated with increased major adverse cardiovascular event (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19-1.65; P<0.0001).
  
  
  
  One in 5 percutaneous coronary intervention-treated myocardial infarction patients stopped ADPri treatment within 1 year. Early cessation was associated with increased major adverse cardiovascular event risk.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.). emil.fosbol@dm.duke.edu elf@heart.dk.
authors: Emil L
authors: EL
authors: Fosbøl
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Christine
authors: C
authors: Ju
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Kevin J
authors: KJ
authors: Anstrom
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Marjorie E
authors: ME
authors: Zettler
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: John C
authors: JC
authors: Messenger
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Ron
authors: R
authors: Waksman
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Mark B
authors: MB
authors: Effron
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Brian A
authors: BA
authors: Baker
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: David J
authors: DJ
authors: Cohen
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Eric D
authors: ED
authors: Peterson
authors: From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
authors: Tracy Y
authors: TY
authors: Wang
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016016:Proportional Hazards Models; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: adenosine diphosphate; major adverse cardiovascular event; myocardial infarction; percutaneous coronary intervention; stent