Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain)
Objectives Guidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the influence of guideline implementation on the trend in...
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BMJ Publishing Group
2019-07-01
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| author | Helena Tizón-Marcos Josepa Mauri Alba Rosas M Hernandez L Recasens Aida Ribera Ignacio Ferreira-Gonzalez Josep Ramon Marsal Gerard Oristrell Maria Teresa Faixedas Sergio Rojas Carlos Labata Merida Cardenas Silvia Homs Carlos Tomas-Querol Joan Garcia-Picart Joan A Gomez-Hospital Monica Masotti David Garcia Dorado C Carvajal P Martínez R M Lidón J Bañeras M Massotti G Jiménez A Regueiro J Basaganyas P Loma E Badosa A Fageda A Ariza A Cequier A Gómez-Hospital G Marín J Maristany V Montoya E Fernández-Nofrerias X Carrillo C Garcia-Garcia C Oliete A Bardaji G Bonet-Pineda Juan F Muñoz F Padilla B Baquerizo A Bosch Gaya F Worner L Barta M Agustí A Gené X Jimenez A Mora J Jiménez |
| author_facet | Helena Tizón-Marcos Josepa Mauri Alba Rosas M Hernandez L Recasens Aida Ribera Ignacio Ferreira-Gonzalez Josep Ramon Marsal Gerard Oristrell Maria Teresa Faixedas Sergio Rojas Carlos Labata Merida Cardenas Silvia Homs Carlos Tomas-Querol Joan Garcia-Picart Joan A Gomez-Hospital Monica Masotti David Garcia Dorado C Carvajal P Martínez R M Lidón J Bañeras M Massotti G Jiménez A Regueiro J Basaganyas P Loma E Badosa A Fageda A Ariza A Cequier A Gómez-Hospital G Marín J Maristany V Montoya E Fernández-Nofrerias X Carrillo C Garcia-Garcia C Oliete A Bardaji G Bonet-Pineda Juan F Muñoz F Padilla B Baquerizo A Bosch Gaya F Worner L Barta M Agustí A Gené X Jimenez A Mora J Jiménez |
| author_sort | Helena Tizón-Marcos |
| collection | DOAJ |
| description | Objectives Guidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the influence of guideline implementation on the trend in 12-month persistence with DAPT between 2010 and 2015 and to evaluate its relationship with DAPT duration regimens recommended at discharge from PCI hospitals.Design Observational study based on region-wide registry data linked to pharmacy billing data for DAPT follow-up.Setting All PCI hospitals (10) belonging to the acute myocardial infarction (AMI) code network in Catalonia (Spain).Participants 10 711 STEACS patients undergoing PCI between 2010 and 2015 were followed up.Primary and secondary outcome measures Primary outcome was 12-month persistence with DAPT. Calendar year quarter, publication of guidelines, DAPT duration regimen recommended in the hospital discharge report, baseline patient characteristics and significant interactions were included in mixed-effects logistic regression based interrupted time-series models.Results The proportion of patients on-DAPT at 12 months increased from 58% (56–60) in 2010 to 73% (71–75) in 2015. The rate of 12-month persistence with DAPT significantly increased after the publication of clinical guidelines with a time lag of 1 year (OR=1.20; 95% CI 1.11 to 1.30). A higher risk profile, more extensive and complex coronary disease, use of drug-eluting stents (OR=1.90; 95% CI 1.50 to 2.40) and a 12-month DAPT regimen recommendation at discharge from the PCI hospital (OR=5.76; 95% CI 3.26 to 10.2) were associated with 12-month persistence.Conclusion Persistence with 12-month DAPT has increased since publication of clinical guidelines. Even though most patients were discharged on DAPT, only 73% with potential indication were on-DAPT 12 months after PCI. A guideline-based recommendation at PCI hospital discharge was highly associated with full persistence with DAPT. Establishing evidence-based, common prescribing criteria across hospitals in the AMI-network would favour adherence and reduce variability. |
| format | Article |
| id | doaj-art-bb9de3f1dda44ef7a790e5f794bd2320 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-07-01 |
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| series | BMJ Open |
| spelling | doaj-art-bb9de3f1dda44ef7a790e5f794bd23202024-11-23T00:45:12ZengBMJ Publishing GroupBMJ Open2044-60552019-07-019710.1136/bmjopen-2018-028114Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain)Helena Tizón-Marcos0Josepa Mauri1Alba Rosas2M Hernandez3L RecasensAida Ribera4Ignacio Ferreira-Gonzalez5Josep Ramon Marsal6Gerard Oristrell7Maria Teresa Faixedas8Sergio Rojas9Carlos Labata10Merida Cardenas11Silvia Homs12Carlos Tomas-Querol13Joan Garcia-Picart14Joan A Gomez-Hospital15Monica Masotti16David Garcia Dorado17C CarvajalP MartínezR M LidónJ BañerasM MassottiG JiménezA RegueiroJ BasaganyasP LomaE BadosaA FagedaA ArizaA CequierA Gómez-HospitalG Marín18J MaristanyV MontoyaE Fernández-NofreriasX CarrilloC Garcia-Garcia19C OlieteA BardajiG Bonet-PinedaJuan F MuñozF PadillaB BaquerizoA Bosch GayaF WornerL BartaM AgustíA GenéX JimenezA MoraJ Jiménez207 CIBERCV, Madrid, Spain3 Departament de Salut, Generalitat de Catalunya, Barcelona, Spain3 Departament de Salut, Generalitat de Catalunya, Barcelona, Spain4H Clinic, Barcelona1 Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment de Medicina, Universitat Autònoma de Barcelona, Hospital General Vall d`HebronFormer employee at IDIAPJGol, Barcelona, Spain16 Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares CIBERCV, Spanish Health Institute (ISCIII), Spain2 Servei Català de la Salut, Generalitat de Catalunya, Barcelona, Spain5 Cardiology Department, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain6 Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain7 Cardiology Department, Hospital Josep Trueta, Girona, Spain8 Cardiology Department, Hospital Mútua de Terrassa, Barcelona, Spain9 Cardiology Department, Hospital Arnau de Vilanova, Lleida, Spain3 Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain11 Cardiology Department, Hospital de Bellvitge, Barcelona, Spain13 Institut Clínic Cardio vascular (ICCV), Hospital Clínic de Barcelona, Barcelona, Spain1 Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain2Department of Statistics, Lapeyronie hospital, Montpellier, France8Departamento de Reumatología, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico1CIR Centre for Inflammation Research, Institute Of Regeneration and Repair, University of Edinburgh, Edinburgh, UKObjectives Guidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the influence of guideline implementation on the trend in 12-month persistence with DAPT between 2010 and 2015 and to evaluate its relationship with DAPT duration regimens recommended at discharge from PCI hospitals.Design Observational study based on region-wide registry data linked to pharmacy billing data for DAPT follow-up.Setting All PCI hospitals (10) belonging to the acute myocardial infarction (AMI) code network in Catalonia (Spain).Participants 10 711 STEACS patients undergoing PCI between 2010 and 2015 were followed up.Primary and secondary outcome measures Primary outcome was 12-month persistence with DAPT. Calendar year quarter, publication of guidelines, DAPT duration regimen recommended in the hospital discharge report, baseline patient characteristics and significant interactions were included in mixed-effects logistic regression based interrupted time-series models.Results The proportion of patients on-DAPT at 12 months increased from 58% (56–60) in 2010 to 73% (71–75) in 2015. The rate of 12-month persistence with DAPT significantly increased after the publication of clinical guidelines with a time lag of 1 year (OR=1.20; 95% CI 1.11 to 1.30). A higher risk profile, more extensive and complex coronary disease, use of drug-eluting stents (OR=1.90; 95% CI 1.50 to 2.40) and a 12-month DAPT regimen recommendation at discharge from the PCI hospital (OR=5.76; 95% CI 3.26 to 10.2) were associated with 12-month persistence.Conclusion Persistence with 12-month DAPT has increased since publication of clinical guidelines. Even though most patients were discharged on DAPT, only 73% with potential indication were on-DAPT 12 months after PCI. A guideline-based recommendation at PCI hospital discharge was highly associated with full persistence with DAPT. Establishing evidence-based, common prescribing criteria across hospitals in the AMI-network would favour adherence and reduce variability.https://bmjopen.bmj.com/content/9/7/e028114.full |
| spellingShingle | Helena Tizón-Marcos Josepa Mauri Alba Rosas M Hernandez L Recasens Aida Ribera Ignacio Ferreira-Gonzalez Josep Ramon Marsal Gerard Oristrell Maria Teresa Faixedas Sergio Rojas Carlos Labata Merida Cardenas Silvia Homs Carlos Tomas-Querol Joan Garcia-Picart Joan A Gomez-Hospital Monica Masotti David Garcia Dorado C Carvajal P Martínez R M Lidón J Bañeras M Massotti G Jiménez A Regueiro J Basaganyas P Loma E Badosa A Fageda A Ariza A Cequier A Gómez-Hospital G Marín J Maristany V Montoya E Fernández-Nofrerias X Carrillo C Garcia-Garcia C Oliete A Bardaji G Bonet-Pineda Juan F Muñoz F Padilla B Baquerizo A Bosch Gaya F Worner L Barta M Agustí A Gené X Jimenez A Mora J Jiménez Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain) BMJ Open |
| title | Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain) |
| title_full | Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain) |
| title_fullStr | Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain) |
| title_full_unstemmed | Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain) |
| title_short | Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain) |
| title_sort | persistence with dual antiplatelet therapy after percutaneous coronary intervention for st segment elevation acute coronary syndrome a population based cohort study in catalonia spain |
| url | https://bmjopen.bmj.com/content/9/7/e028114.full |
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