Mori Yuichiro, Friede Tim, Hattori Satoshi, Yamaji Kyohei, Fukuma Shingo
Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Lower Saxony, Göttingen, Germany.
JACC Asia. 2025 Jun;5(6):758-768. doi: 10.1016/j.jacasi.2025.03.008. Epub 2025 May 13.
Lifelong antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is strongly recommended. However, the extent and temporal variation in the risk of nonadherence to this recommendation remain unclear.
The aim of this study was to investigate how nonadherence to any antiplatelet therapy after PCI affects critical cardiac events and whether this effect varies over time.
This cohort study analyzed Japanese nationwide insurance claims and health checkup records of working-age patients who underwent PCI with DES between April 2016 and March 2022. Nonadherence was defined as prescription coverage of antiplatelet therapy <50% within preceding 90 days. Landmark-time survival analysis with propensity-score matching was conducted every 5 days from 90th to 1,095th days after PCI. The primary outcome was a composite of all-cause death, myocardial infarction, or cardiopulmonary arrest. Results were synthesized to assess temporal variation in the risk magnitude.
Among 40,902 patients (mean age, 58.3 ± 8.3 years; 5.5% women [2,240 of 40,902], median [IQR] follow-up: 653 days [Q1-Q3: 235-1,233 days]), nonadherence was observed in 1.18% (421 of 35,582) at 90 days and 4.70% (579 of 12,312) at 1,095 days after PCI. Critical cardiac events were more frequent in nonadherent patients (HR: 2.50 [95% CI: 1.92-3.26]; P < 0.001), with no significant temporal variation across landmark times.
Nonadherence to any antiplatelet therapy after PCI was associated with a more than 2-fold increase in critical cardiac events, irrespective of post-PCI timing throughout 3 years. These findings emphasize the need for sustained efforts by health care providers and patients to maintain drug adherence over a prolonged period.
强烈推荐在药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）后进行终身抗血小板治疗。然而，不遵守该建议的风险程度和时间变化仍不清楚。
本研究旨在调查PCI后不遵守任何抗血小板治疗如何影响严重心脏事件，以及这种影响是否随时间变化。
这项队列研究分析了2016年4月至2022年3月期间接受DES PCI的日本全国在职年龄患者的保险理赔和健康检查记录。不遵守定义为前90天内抗血小板治疗的处方覆盖率<50%。在PCI后第90天至1095天，每隔5天进行一次倾向评分匹配的标志性时间生存分析。主要结局是全因死亡、心肌梗死或心肺骤停的复合结局。综合结果以评估风险程度的时间变化。
在40902例患者中（平均年龄58.3±8.3岁；5.5%为女性[40902例中的2240例]，中位[IQR]随访时间：653天[Q1-Q3：235-1233天]），PCI后90天时1.18%（35582例中的421例）和1095天时4.70%（12312例中的579例）出现不遵守情况。不遵守治疗的患者发生严重心脏事件的频率更高（HR：2.50[95%CI：1.92-3.26]；P<0.001），在各个标志性时间点无显著的时间变化。
PCI后不遵守任何抗血小板治疗与严重心脏事件增加2倍以上相关，在整个3年的PCI后时间内均如此。这些发现强调了医疗保健提供者和患者需要长期持续努力以维持药物依从性。
