Patients Adherence to Dual Antiplatelet after Percutaneous Coronary Intervention with Drug Eluting Stent Covered by Government Insurance (Sehat Card Plus Program)- An Experience from a Large Tertiary Care Cardiac Center in a Low to Middle Income Country
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Abstract
Background: Percutaneous coronary intervention (PCI) is a critical procedure for patients with coronary artery disease. Ensuring adherence to dual antiplatelet therapy (DAPT) post-PCI is essential for optimal patient outcomes. This study explores the impact of DAPT adherence on patient health and mortality rates in a hospital setting.
Objective: To investigate the outcomes associated with patient adherence to DAPT following PCI.
Methods: This cross-sectional study enrolled 502 PCI patients at the Peshawar Institute of Cardiology from November 2022 to October 2023. All patients were prescribed DAPT and followed up 7 months post-PCI. Data were collected using a pre-designed questionnaire and analyzed with SPSS Version 25.
Results: The study enrolled 502 patients with a mean age of 60.19 ± 10.01 years. Among them, 66.5% (334) were male, and 33.5% (168) were female. Adherence to DAPT was 100%, with a mortality rate of 0.2% (1 patient). All patients were educated. The prevalence rates for diabetes mellitus, hypertension, and tobacco use were 19.9% (100 patients), 35.1% (176 patients), and 8.6% (43 patients), respectively.
Conclusion: The study concluded that high adherence to DAPT post-PCI is significantly associated with improved patient health and a low mortality rate.
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References
Navarese EP, Andreotti F, Schulze V, Kołodziejczak M, Buffon A, Brouwer M, et al. Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials. bmj. 2015;350.
Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal. 2019;40(2):87-165.
Prasad A, Herrmann J. Myocardial infarction due to percutaneous coronary intervention. New England Journal of Medicine. 2011;364(5):453-64.
Cao D, Chandiramani R, Chiarito M, Claessen BE, Mehran R. Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey. European Heart Journal. 2021;42(4):339-51.
Capodanno D, Alfonso F, Levine GN, Valgimigli M, Angiolillo DJ. ACC/AHA versus ESC guidelines on dual antiplatelet therapy: JACC guideline comparison. Journal of the American College of Cardiology. 2018;72(23 Part A):2915-31.
Patrono C, García Rodríguez LA, Landolfi R, Baigent C. Low-dose aspirin for the prevention of atherothrombosis. New England Journal of Medicine. 2005;353(22):2373-83.
Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2016;134(10):e123-e55.
Luu NM, Dinh AT, Nguyen TTH, Nguyen VH. Adherence to antiplatelet therapy after coronary intervention among patients with myocardial infarction attending Vietnam National Heart Institute. BioMed research international. 2019;2019.
Abbott JD, Vlachos HA, Selzer F, Sharaf BL, Holper E, Glaser R, et al. Gender-based outcomes in percutaneous coronary intervention with drug-eluting stents (from the National Heart, Lung, and Blood Institute Dynamic Registry). The American journal of cardiology. 2007;99(5):626-31.
Urban P, Gershlick AH, Guagliumi G, Guyon P, Lotan C, Schofer J, et al. Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. Circulation. 2006;113(11):1434-41.
Shroff A, Ali A, Groo VL. Clopidogrel adherence following percutaneous coronary intervention with a drug-eluting stent in a VA Medical Center. Journal of Pharmacy Technology. 2009;25(3):164-8.
Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006;113(24):2803-9.
Gaglia MA, Torguson R, Xue Z, Gonzalez MA, Collins SD, Ben-Dor I, et al. Insurance type influences the use of drug-eluting stents. JACC: Cardiovascular Interventions. 2010;3(7):773-9.
Naidu SS, Krucoff MW, Rutledge DR, Mao VW, Zhao W, Zheng Q, et al. Contemporary incidence and predictors of stent thrombosis and other major adverse cardiac events in the year after XIENCE V implantation: results from the 8,061-patient XIENCE V United States study. JACC: Cardiovascular Interventions. 2012;5(6):626-35.
Blich M, Zeidan-Shwiri T, Petcherski S, Osherov A, Hammerman H. Incidence, predictors and outcome of drug-eluting stent thrombosis in real-world practice. The Journal of invasive cardiology. 2010;22(10):461-4.
Hammoudeh AJ, Alhaddad IA, Khader Y, Tabbalat R, Al-Mousa E, Saleh A, et al. Cardiovascular risk factors in Middle Eastern patients undergoing percutaneous coronary intervention: results from the first Jordanian percutaneous coronary intervention study. Journal of the Saudi Heart Association. 2017;29(3):195-202.
Jarrah MI, Al-Khatib S, Khader Y, AlKharabsheh HN, Hammoudeh A, Alzoubi KH, et al. The impact of coexistence of smoking and diabetes on the coronary artery severity and outcomes following percutaneous coronary intervention: results from the 1ST Jordanian PCI Registry. International Journal of Vascular Medicine. 2020;2020.