University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil.
Am J Cardiol. 2011 Mar 1;107(5):685-9. doi: 10.1016/j.amjcard.2010.10.045. Epub 2010 Dec 22.
We sought to identify patients at risk for premature discontinuation of thienopyridines and to develop a risk score for thienopyridine adherence after coronary stent implantation. Patients were prospectively included from December 2007 to March 2008. At 1-month follow-up, all patients were given the Morisky questionnaire and asked if they had stopped taking thienopyridines. Multivariate analysis identified predictors of thienopyridine discontinuation; points were assigned to each variable according to the odds ratios and the c-statistic of the score was calculated. Mean age of the 400 patients included was 61.0 ± 10.4 years; 66 patients (16.5%) stopped thienopyridines after 1 month. Reasons for discontinuation were cost (62%), lack of information (17%), and recommendation by another doctor to stop treatment (15%). Factors associated with discontinuation included unmarried status (odds ratio 2.48, p = 0.046), lack of private health insurance (odds ratio 4.68, p = 0.041), acute coronary syndrome (odds ratio 2.31, p = 0.004), nondiabetics (odds ratio 2.20, p = 0.041), and patients who earned <2 times (odds ratio 8.23, p <0.001) and 2 to 3 times (odds ratio 4.46, p = 0.021) the minimum wage. Total risk score was 0 to 14 points and was strongly associated with thienopyridine discontinuation. For total scores of 0 to 4, 5 to 8, 9 to 12, and ≥13, 0%, 7%, 20%, and 37% of patients, respectively, stopped thienopyridines (c-statistic 0.76, p <0.0001). Risk score was also significantly associated with complete adherence as assessed by the Morisky questionnaire (c-statistic 0.74, p <0.001). In conclusion, we have identified patients at risk for premature discontinuation of thienopyridines using variables obtained before stent implantation and developed a risk score that accurately predicts premature thienopyridine discontinuation.
我们旨在确定噻吩吡啶类药物过早停药的高危患者，并制定冠状动脉支架植入术后噻吩吡啶类药物依从性的风险评分。患者于 2007 年 12 月至 2008 年 3 月期间前瞻性入选。在 1 个月随访时，所有患者均接受 Morisky 问卷并询问是否已停止服用噻吩吡啶类药物。多变量分析确定了噻吩吡啶类药物停药的预测因素；根据评分的优势比和 C 统计量为每个变量分配分数。纳入的 400 例患者的平均年龄为 61.0 ± 10.4 岁；1 个月后有 66 例（16.5%）停止服用噻吩吡啶类药物。停药的原因是费用（62%）、缺乏信息（17%）和其他医生建议停药（15%）。与停药相关的因素包括未婚状态（比值比 2.48，p = 0.046）、无私人医疗保险（比值比 4.68，p = 0.041）、急性冠脉综合征（比值比 2.31，p = 0.004）、非糖尿病患者（比值比 2.20，p = 0.041）和收入低于最低工资 2 倍（比值比 8.23，p <0.001）和 2 至 3 倍（比值比 4.46，p = 0.021）的患者。总风险评分 0 至 14 分，与噻吩吡啶类药物停药密切相关。总分为 0 至 4、5 至 8、9 至 12 和≥13 分的患者分别有 0%、7%、20%和 37%停止服用噻吩吡啶类药物（C 统计量 0.76，p <0.0001）。风险评分与 Morisky 问卷评估的完全依从性也显著相关（C 统计量 0.74，p <0.001）。结论：我们使用支架植入前获得的变量确定了噻吩吡啶类药物过早停药的高危患者，并制定了一个能够准确预测噻吩吡啶类药物过早停药的风险评分。
