Circulation. 2006;113:2803-2809
Published online before print June 12, 2006, doi: 10.1161/CIRCULATIONAHA.106.618066
Published online before print June 12, 2006, doi: 10.1161/CIRCULATIONAHA.106.618066
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(Circulation. 2006;113:2803-2809.)
© 2006 American Heart Association, Inc.
Coronary Heart Disease |
Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug-Eluting Stent Placement
Results From the PREMIER Registry
From the Mid America Heart Institute and the University of Missouri at Kansas City (J.A.S., R.K., C.V., C.D., P.G.J.); the University of Colorado Hospital/Denver VA Medical Center (J.S.R.), Denver, Colo; the University of Colorado Health Sciences Center (J.C.M.), Denver; the Henry Ford Health System (S.K.), Detroit, Mich; Duke University (E.D.P.), Durham, NC; Barnes-Jewish Hospital and Washington University School of Medicine (R.G.B.), St. Louis, Mo; Yale University (H.M.K.), New Haven, Conn; and Beth Israel–Deaconess Medical Center (D.J.C.), Boston, Mass.
Correspondence to John Spertus, MD, MPH, Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail spertusj{at}umkc.edu
Received February 1, 2006; revision received April 11, 2006; accepted April 20, 2006.
Background— Although drug-eluting stents (DES) significantly reduce restenosis, they require 3 to 6 months of thienopyridine therapy to prevent stent thrombosis. The rate and consequences of prematurely discontinuing thienopyridine therapy after DES placement for acute myocardial infarction (MI) are unknown.
Methods and Results— We used prospectively collected data from a 19-center study of MI patients to examine the prevalence and predictors of thienopyridine discontinuation 30 days after DES treatment. We then compared the mortality and cardiac hospitalization rates for the next 11 months between those who stopped and those who continued thienopyridine therapy. Among 500 DES-treated MI patients who were discharged on thienopyridine therapy, 68 (13.6%) stopped therapy within 30 days. Those who stopped were older, less likely to have completed high school or be married, more likely to avoid health care because of cost, and more likely to have had preexisting cardiovascular disease or anemia at presentation. They were also less likely to have received discharge instructions about their medications or a cardiac rehabilitation referral. Patients who stopped thienopyridine therapy by 30 days were more likely to die during the next 11 months (7.5% versus 0.7%, P<0.0001; adjusted hazard ratio=9.0; 95% confidence interval=1.3 to 60.6) and to be rehospitalized (23% versus 14%, P=0.08; adjusted hazard ratio=1.5; 95% confidence interval=0.78 to 3.0).
Conclusions— Almost 1 in 7 MI patients who received a DES were no longer taking thienopyridines by 30 days. Prematurely stopping thienopyridine therapy was strongly associated with subsequent mortality. Strategies to improve the use of thienopyridines are needed to optimize the outcomes of MI patients treated with DES.
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S. Kaul, P. K. Shah, and G. A. Diamond As Time Goes By: Current Status and Future Directions in the Controversy Over Stenting J. Am. Coll. Cardiol., July 10, 2007; 50(2): 128 - 137. [Abstract] [Full Text] [PDF]
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R. Jaffe and B. H. Strauss Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives J. Am. Coll. Cardiol., July 10, 2007; 50(2): 119 - 127. [Abstract] [Full Text] [PDF]
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D. R. Holmes Jr, D. J. Kereiakes, W. K. Laskey, A. Colombo, S. G. Ellis, T. D. Henry, J. J. Popma, P. W.J.C. Serruys, T. Kimura, D. O. Williams, et al. Thrombosis and Drug-Eluting Stents: An Objective Appraisal J. Am. Coll. Cardiol., July 10, 2007; 50(2): 109 - 118. [Abstract] [Full Text] [PDF]
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S. A. Spinler and R. L. Wilensky Duration of clopidogrel therapy after placement of drug-eluting intracoronary stent Am. J. Health Syst. Pharm., July 1, 2007; 64(13): 1432 - 1434. [Full Text] [PDF]
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J. T. Dove, D. J. Moliterno, W. D. Weaver, and M. E. Shelton President's Page: Drug-Eluting Stents in Contemporary Practice--A Call for a Real-World, Open-Entry, Device-Tracking Registry J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2223 - 2226. [Full Text] [PDF]
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H. K. Win, A. E. Caldera, K. Maresh, J. Lopez, C. S. Rihal, M. A. Parikh, J. F. Granada, S. Marulkar, D. Nassif, D. J. Cohen, et al. Clinical Outcomes and Stent Thrombosis Following Off-Label Use of Drug-Eluting Stents JAMA, May 9, 2007; 297(18): 2001 - 2009. [Abstract] [Full Text] [PDF]
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A. V. Finn, M. Joner, G. Nakazawa, F. Kolodgie, J. Newell, M. C. John, H. K. Gold, and R. Virmani Pathological Correlates of Late Drug-Eluting Stent Thrombosis: Strut Coverage as a Marker of Endothelialization Circulation, May 8, 2007; 115(18): 2435 - 2441. [Abstract] [Full Text] [PDF]
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C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians J Am Dent Assoc, May 1, 2007; 138(5): 652 - 655. [Abstract] [Full Text] [PDF]
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A. O. Maree and D. J. Fitzgerald Variable Platelet Response to Aspirin and Clopidogrel in Atherothrombotic Disease Circulation, April 24, 2007; 115(16): 2196 - 2207. [Full Text] [PDF]
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R. J. Gibbons Leading the Elephant Out of the Corner: The Future of Health Care: Presidential Address at the American Heart Association 2006 Scientific Sessions Circulation, April 24, 2007; 115(16): 2221 - 2230. [Full Text] [PDF]
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B. J.G.L. de Smet and F. Zijlstra A look at drug eluting stents with optical coherence tomography Eur. Heart J., April 2, 2007; 28(8): 918 - 919. [Full Text] [PDF]
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S. Eshaghian, S. Kaul, S. Amin, P. K. Shah, and G. A. Diamond Role of Clopidogrel in Managing Atherothrombotic Cardiovascular Disease Ann Intern Med, March 20, 2007; 146(6): 434 - 441. [Abstract] [Full Text] [PDF]
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E. Camenzind, P. G. Steg, and W. Wijns A Cause for Concern Circulation, March 20, 2007; 115(11): 1440 - 1455. [Full Text] [PDF]
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S. G. Ellis, A. Colombo, E. Grube, J. Popma, J. Koglin, K. D. Dawkins, and G. W. Stone Incidence, Timing, and Correlates of Stent Thrombosis With the Polymeric Paclitaxel Drug-Eluting Stent: A TAXUS II, IV, V, and VI Meta-Analysis of 3,445 Patients Followed for Up to 3 Years J. Am. Coll. Cardiol., March 13, 2007; 49(10): 1043 - 1051. [Abstract] [Full Text] [PDF]
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C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians J. Am. Coll. Cardiol., February 13, 2007; 49(6): 734 - 739. [Abstract] [Full Text] [PDF]
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C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians Circulation, February 13, 2007; 115(6): 813 - 818. [Abstract] [Full Text] [PDF]
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