Impact of medication adherence to dual antiplatelet therapy on the long-term outcome of drug-eluting or bare-metal stents

PLoS One. 2020 Dec 16;15(12):e0244062. doi: 10.1371/journal.pone.0244062. eCollection 2020.

Abstract

Background: In percutaneous coronary intervention, drug-eluting stent (DES) showed better clinical outcome compared to bare-metal stent (BMS) but mostly with different DAPT durations.

Hypothesis: The clinical superiority of DES over BMS may depend on the medication adherence to dual antiplatelet therapy (DAPT).

Methods: We retrospectively enrolled all Koreans PCI patients in year 2011 (n = 47,291). Medication adherence to DAPT was assessed by proportion of days covered (PDC) per 6 months. Analysis adjusted with the clinical propensity for receiving DES or BMS and DAPT PDC of the first 6 month was performed. Primary outcome was the 5-year major adverse clinical event (MACE) risk consisting all-cause death, revascularization, shock, or stroke.

Results: Patients with DES (n = 46,356) showed higher PDC (78% versus 60%, p<0.001) and lower MACE risk (39% versus 56%, p<0.001) compared to patients with BMS (n = 935). In the propensity-matched 1,868 patients, MACE risk was lower with DES than BMS (46% versus 54%, HR = 0.80, 95% CI = 0.70-0.91, p<0.001). In both DES and BMS, patients with good medication adherence (PDC ≥80%) showed much lower MACE risk compared to patients with PDC <80% (HR = 0.36, 95% CI = 0.30-0.44; HR = 0.40, 95%CI = 0.33-0.48, p<0.001, all). Patients with DES and PDC <80% showed higher MACE risk compared to BMS with and PDC ≥80% (HR = 1.30, 95%CI = 1.03-1.64, p = 0.027).

Conclusions: Good medication adherence to DAPT in the first 6 month was prerequisite for better clinical outcome in both DES and BMS. DES with poor adherence to DAPT showed worse outcome compared with BMS with good adherence.

Publication types

  • Clinical Trial
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Disease-Free Survival
  • Drug-Eluting Stents*
  • Female
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Retrospective Studies
  • Risk Factors
  • Stroke* / etiology
  • Stroke* / mortality
  • Survival Rate

Substances

  • Platelet Aggregation Inhibitors

Grants and funding

This study was supported by National Research Foundation of Korea (2017R1A2B310918) and Multi-Ministry development program for AI-Bio-Robot-Medicine Convergence (#20001234) to Jin-Ho Choi. The funders had no role in study design, data collectionand analysis, decision to publish, or preparation of the manuscript.