Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Eur Heart J. 2022 Jun 21;43(24):2303-2313. doi: 10.1093/eurheartj/ehac116.
Post-acute coronary syndrome (ACS) P2Y12 inhibitor non-adherence is common and associated with greater risk of major adverse cardiovascular events (MACEs). Non-adherence can follow different trajectories from an inability to initiate, implement, or continue therapy for the intended duration. We aimed to evaluate P2Y12 inhibitor adherence trajectories among ACS patients treated with percutaneous coronary intervention (PCI), their frequency, and association with MACE.
We conducted a cohort study of adults discharged alive after PCI for ACS (2012-16) using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry linked with administrative data. The primary outcome was P2Y12 inhibitor adherence trajectory in the year after PCI assessed using group-based trajectory modelling. We used logistic regression and Cox proportional-hazards regression to assess associations of trajectories with risk factors and MACE, respectively. We included 12 844 patients (mean age 62.4 years, 23.6% female). Five trajectories were identified: early consistent non-adherence (11.0%), rapid decline (7.7%), delayed initiation (6.0%), gradual decline (20.5%), and persistent adherence (54.8%). Compared with persistent adherence, rapid decline [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.01-1.49] and delayed initiation (HR 1.41, 95% CI 1.12-1.78) were associated with higher MACE in the overall cohort, whereas early consistent non-adherence was associated with higher MACE only in the subgroup receiving a drug-eluting stent (HR 2.44, 95% CI 1.60-3.71).
After PCI for ACS, patients followed one of five distinct P2Y12 inhibitor adherence trajectories. Rapid decline and delayed initiation were associated with a higher risk of MACE, whereas early consistent non-adherence was only associated with higher MACE risk in patients with a drug-eluting stent.
急性冠脉综合征（ACS）后 P2Y12 抑制剂依从性差较为常见，且与主要不良心血管事件（MACE）风险增加相关。依从性差可能会表现为无法开始、实施或持续治疗，也可能表现为无法按照预期持续治疗。我们旨在评估经皮冠状动脉介入治疗（PCI）治疗的 ACS 患者的 P2Y12 抑制剂依从性轨迹及其频率，并分析其与 MACE 的相关性。
我们对 2012 年至 2016 年期间使用 Alberta 省级冠心病预后评估项目（APOPCARE）注册中心与行政数据相链接的 PCI 治疗后存活出院的 ACS 成年患者进行了一项队列研究。主要结局是使用基于群组的轨迹建模方法评估 PCI 后 1 年内 P2Y12 抑制剂的依从性轨迹。我们使用逻辑回归和 Cox 比例风险回归分别评估轨迹与危险因素和 MACE 的相关性。我们纳入了 12844 例患者（平均年龄 62.4 岁，23.6%为女性）。共确定了 5 种轨迹：早期持续不依从（11.0%）、快速下降（7.7%）、延迟开始（6.0%）、逐渐下降（20.5%）和持续依从（54.8%）。与持续依从相比，在整个队列中，快速下降（HR 1.23，95%CI 1.01-1.49）和延迟开始（HR 1.41，95%CI 1.12-1.78）与 MACE 风险更高相关，而早期持续不依从仅在接受药物洗脱支架的亚组中与更高的 MACE 风险相关（HR 2.44，95%CI 1.60-3.71）。
在 ACS 行 PCI 治疗后，患者依从性表现为 5 种不同的 P2Y12 抑制剂依从性轨迹中的一种。快速下降和延迟开始与 MACE 风险增加相关，而早期持续不依从仅与接受药物洗脱支架的患者的更高 MACE 风险相关。
