强效 P2Y12 抑制剂与氯吡格雷在急性冠脉综合征后预测抗血小板治疗的依从性：来自 IDEAL-LDL 的观察。
Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL.
机构信息
Department of Cardiology, AHEPA University Hospital, 54621 Thessaloniki, Greece.
出版信息
Rev Cardiovasc Med. 2022 Mar 3;23(3):81. doi: 10.31083/j.rcm2303081.
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 ( = 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://clinicaltrials.gov/ct2/show/NCT02927808.
背景
在急性冠状动脉综合征（ACS）后，强效 P2Y12 抑制剂优于氯吡格雷，这一点已得到充分证实，然而强效 P2Y12 抑制会导致更多的不良事件，这可能会影响患者对治疗的依从性。本研究旨在探讨 ACS 后接受双联抗血小板治疗（DAPT）的患者对处方 P2Y12 抑制剂（P2Y12i）的依从性。
方法
在 IDEAL-LDL 试验的子研究中，我们纳入了 344 例 ACS 出院后接受 DAPT 的患者。主要结局是强效 P2Y12i 和氯吡格雷在依从性方面的差异，以及其他与抗血小板方案依从性相关的预测因素。次要结局包括 DAPT 持续时间及其预测因素，以及 DAPT 后的抗血小板方案选择。
结果
140/178（78.7%）和 111/166（66.9%）例患者分别观察到对强效 P2Y12i 和氯吡格雷的依从性（=0.016）。在多变量模型中，调整治疗第一年 P2Y12i 转换后，强效 P2Y12i 和氯吡格雷之间的依从性无差异（比值比[OR] =0.98，95%置信区间[CI] =0.55-1.74）。显著的预测因素包括心血管疾病（CVD）史（OR=0.51，95%CI=0.31-0.86）和经皮冠状动脉介入治疗（PCI）指数事件治疗（OR=2.58，95%CI=1.38-4.82）。患者中有 72%继续 DAPT >12 个月，女性是 DAPT 延长的负性预测因素（校正 OR=0.43，95%CI=0.21-0.90）。DAPT 持续至随访结束的比例为 42.7%，54.6%的患者继续使用单抗血小板方案。
结论
DAPT 的依从性不受 P2Y12i 效力的影响，而 CVD 史和 PCI 治疗与降低和增加的依从性相关。
临床试验注册
NCT02927808，https://clinicaltrials.gov/ct2/show/NCT02927808。
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