Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL
Olga Kourti, Orestis Konstantas, Ioannis Τ Farmakis, Stefanos Zafeiropoulos, Georgios Psarakis, Elena Vrana, Amalia Baroutidou, Spyridon Graidis, Aikaterini-Vassiliki Touriki, Christos Tsolakidis, Konstantina Spyridaki, Thomas Psathas, Anastasia Daniilidou, Haralambos Karvounis, George Giannakoulas, Olga Kourti, Orestis Konstantas, Ioannis Τ Farmakis, Stefanos Zafeiropoulos, Georgios Psarakis, Elena Vrana, Amalia Baroutidou, Spyridon Graidis, Aikaterini-Vassiliki Touriki, Christos Tsolakidis, Konstantina Spyridaki, Thomas Psathas, Anastasia Daniilidou, Haralambos Karvounis, George Giannakoulas
Abstract
Background: Superiority of potent P2Y12 inhibitors over clopidogrel after an acute coronary syndrome (ACS) has been well established, however potent P2Y12 inhibition is responsible for more adverse events, which may influence patient adherence to treatment. Aim of the present study is to investigate the adherence to the prescribed P2Y12 inhibitor (P2Y12i) in patients on dual antiplatelet therapy (DAPT) after an ACS.
Methods: In an IDEAL-LDL trial substudy, we included 344 patients after ACS discharged on DAPT. The primary outcome was the difference between potent P2Y12i and clopidogrel in terms of adherence, as well as other predictors of adherence to the antiplatelet regimen. Secondary outcomes included the prevalence of DAPT continuation and its predictors and the antiplatelet regimen selection after DAPT.
Results: Adherence to the potent P2Y12i and to clopidogrel was observed in 140/178 (78.7%) and 111/166 (66.9%) patients (p = 0.016), respectively. In the multivariate model, after adjustment for P2Y12i switching during the first year of therapy, there was no difference observed in adherence between potent P2Y12i and clopidogrel (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.55-1.74). Significant predictors included history of cardiovascular disease (CVD) (OR = 0.51, 95% CI = 0.31-0.86) and percutaneous coronary intervention (PCI) index event treatment (OR = 2.58, 95% CI = 1.38-4.82). Of patients, 72% continued DAPT >12 months and female gender was a negative predictor of DAPT prolongation (adjusted OR = 0.43, 95% CI = 0.21-0.90). DAPT was continued until the end of follow-up in 42.7%, while 54.6% resumed with single antiplatelet regimen.
Conclusions: Adherence to DAPT was not affected by the P2Y12i potency, whereas history of CVD and PCI treatment were associated with reduced and increased adherence, respectively.
Clinical trial registration: NCT02927808, https://ichgcp.net/clinical-trials-registry/NCT02927808.
Keywords: P2Y12 inhibitors; acute coronary syndromes; adherence; clopidogrel; prasugrel; ticagrelor.
Conflict of interest statement
The authors declare no conflict of interest. George Giannakoulas is serving as one of the Editorial Board members of this journal. We declare that George Giannakoulas had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Salvatore De Rosa.
© 2022 The Author(s). Published by IMR Press.
Source: PubMed